Rectal bleeding after radiation therapy for endometrial cancer

Abstract

Background & Purpose The goals of this study were to determine the rate and risk factors of rectal bleeding (RB) after external beam radiotherapy and vaginal brachytherapy (EBRT+VB), and to compare this data to previously unreported RB rates from PORTEC-2 patients receiving EBRT or VB alone. Materials & Methods Retrospective chart review identified 212 endometrial cancer patients receiving adjuvant EBRT+VB between 2006–2013. Patient-reported RB data were also obtained from PORTEC-2 patients randomized to EBRT (n=166) or VB (n=182). The two populations were compared using an RB Scale of symptom severity. Results After a median 35 months, 17.9% of EBRT+VB patients (n=38) experienced any RB with 1.9% (n=4) having bleeding requiring intervention. Age ≤70 years was the only predictor of RB (OR 2.8; 95% CI 1.1–8.7; p=0.027). Rates of patient-reported RB after EBRT were similar with 15.0% (n=25) having any RB and 0.6% (n=1) having “very much” bleeding. On regression analysis, any EBRT (either EBRT alone or EBRT+VB) increased the risk of RB compared to those who received VB alone (OR 3.0; p=0.0028; 95% CI 1.4–6.7). The rates of more severe RB were low and did not significantly differ between treatments. Conclusions Significant RB is rare after radiation. The addition of VB to EBRT does not significantly alter bleeding rates.

Second primary colorectal cancer among endometrial cancer survivor: shared etiology and treatment sequelae

“…However, this early decrease might be explained by a hidden treatment effect of pelvic radiotherapy on microscopic or early rectal cancer. In contrast, the late effect of radiotherapy might increase the risk of secondary cancer, consistent with both the present findings and our previous findings (Mitra et al 2015 ). This further supports the need for rectal cancer surveillance among long-term survivors of EC who have undergone pelvic radiotherapy.…”

“…The increased risk of rectal cancer might be explained by late sequelae of pelvic radiotherapy given to treat primary EC. Rectal bleeding due to rectitis occurs in approximately 18% of women who receive pelvic radiotherapy for EC; it is also a manifestation of the late sequelae of pelvic radiotherapy (Mitra et al 2015 ). The risk of rectal cancer was higher (SIR, 1.90, 95% CI 1.74–2.09) among 104,760 cancer survivors (from 13 institutions in 5 countries with more than 40 years of follow-up) who received pelvic radiotherapy, than in the general population.…”

MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer

“…Vance et al (23) reported relatively better 2- and 5-year disease-specific (90%, 77%) and overall survival (84%, 72%) rates among women with early-stage EC (87% FIGO stage I and 13% FIGO stage II disease). Fokdal et al (38) showed 2-year LC of 92%, with disease-free survival and overall survival rates of 59% and 78% respectively. In contrast, Jhingran et al (1) showed lower 2-year LC (82%) and OS (69%) rates, when compared to our MR-based ISBT subgroup.…”

“…Rectal bleeding is most related to the use of external beam RT (38). Three-year actuarial local control, progression-free, and overall survival rates were 100%, 88%, and 87%, respectively, for patients who received MR-guided ISBT; and 78%, 62%, 84%, respectively, for patients who had CT-based treatment.…”

Rectal bleeding

“…Radiation proctitis is an inflammation of the distal rectum, which occurs in patients treated for genitourinary or gynaecological malignancies. Symptoms include bloody diarrhoea and cramps that can develop within weeks to years after initiation of radiotherapy of the pelvic region (Mitra et al., 2015).…”