Pathophysiology and Natural History of Anorectal Sequelae Following Radiation Therapy for Carcinoma of the Prostate
Purpose To characterize the prevalence, pathophysiology, and natural history of chronic radiation proctitis 5 years following radiation therapy (RT) for localized carcinoma of the prostate. Methods and Materials Studies were performed in 34 patients (median age 68 years; range 54-79) previously rand...
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creator | Yeoh, Eric K., MD, FRCP (Edin), FRCR, FRANZCR Holloway, Richard H., MD, FRACP Fraser, Robert J., PhD, FRACP Botten, Rochelle J., BSc (Hons) Di Matteo, Addolorata C., BSc(Hons) Butters, Julie, BHSc |
description | Purpose To characterize the prevalence, pathophysiology, and natural history of chronic radiation proctitis 5 years following radiation therapy (RT) for localized carcinoma of the prostate. Methods and Materials Studies were performed in 34 patients (median age 68 years; range 54-79) previously randomly assigned to either 64 Gy in 32 fractions over 6.4 weeks or 55 Gy in 20 fractions over 4 weeks RT schedule using 2- and later 3-dimensional treatment technique for localized prostate carcinoma. Each patient underwent evaluations of ( 1 ) gastrointestinal (GI) symptoms (Modified Late Effects in Normal Tissues Subjective, Objective, Management and Analytic scales including effect on activities of daily living [ADLs]); ( 2 ) anorectal motor and sensory function (manometry and graded balloon distension); and ( 3 ) anal sphincteric morphology (endoanal ultrasound) before RT, at 1 month, and annually for 5 years after its completion. Results Total GI symptom scores increased after RT and remained above baseline levels at 5 years and were associated with reductions in ( 1 ) basal anal pressures, ( 2 ) responses to squeeze and increased intra-abdominal pressure, ( 3 ) rectal compliance and ( 4 ) rectal volumes of sensory perception. Anal sphincter morphology was unchanged. At 5 years, 44% and 21% of patients reported urgency of defecation and rectal bleeding, respectively, and 48% impairment of ADLs. GI symptom scores and parameters of anorectal function and anal sphincter morphology did not differ between the 2 RT schedules or treatment techniques. Conclusions Five years after RT for prostate carcinoma, anorectal symptoms continue to have a significant impact on ADLs of almost 50% of patients. These symptoms are associated with anorectal dysfunction independent of the RT schedules or treatment techniques reported here. |
doi_str_mv | 10.1016/j.ijrobp.2012.06.032 |
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Methods and Materials Studies were performed in 34 patients (median age 68 years; range 54-79) previously randomly assigned to either 64 Gy in 32 fractions over 6.4 weeks or 55 Gy in 20 fractions over 4 weeks RT schedule using 2- and later 3-dimensional treatment technique for localized prostate carcinoma. Each patient underwent evaluations of ( 1 ) gastrointestinal (GI) symptoms (Modified Late Effects in Normal Tissues Subjective, Objective, Management and Analytic scales including effect on activities of daily living [ADLs]); ( 2 ) anorectal motor and sensory function (manometry and graded balloon distension); and ( 3 ) anal sphincteric morphology (endoanal ultrasound) before RT, at 1 month, and annually for 5 years after its completion. Results Total GI symptom scores increased after RT and remained above baseline levels at 5 years and were associated with reductions in ( 1 ) basal anal pressures, ( 2 ) responses to squeeze and increased intra-abdominal pressure, ( 3 ) rectal compliance and ( 4 ) rectal volumes of sensory perception. Anal sphincter morphology was unchanged. At 5 years, 44% and 21% of patients reported urgency of defecation and rectal bleeding, respectively, and 48% impairment of ADLs. GI symptom scores and parameters of anorectal function and anal sphincter morphology did not differ between the 2 RT schedules or treatment techniques. Conclusions Five years after RT for prostate carcinoma, anorectal symptoms continue to have a significant impact on ADLs of almost 50% of patients. These symptoms are associated with anorectal dysfunction independent of the RT schedules or treatment techniques reported here.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2012.06.032</identifier><identifier>PMID: 22836050</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Activities of Daily Living ; Aged ; Anal Canal - diagnostic imaging ; Anal Canal - physiopathology ; Anal Canal - radiation effects ; BALLOONS ; Carcinoma - radiotherapy ; CARCINOMAS ; EVALUATION ; Hematology, Oncology and Palliative Medicine ; Humans ; Male ; Middle Aged ; MORPHOLOGY ; PATIENTS ; Pressure ; PROCTITIS ; Proctitis - etiology ; Proctitis - physiopathology ; Prospective Studies ; PROSTATE ; Prostatic Neoplasms - physiopathology ; Prostatic Neoplasms - radiotherapy ; Radiation Injuries - complications ; Radiation Injuries - physiopathology ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; RADIOTHERAPY ; Radiotherapy Dosage ; RECTUM ; Rectum - diagnostic imaging ; Rectum - physiopathology ; Rectum - radiation effects ; Reflex - physiology ; Reflex - radiation effects ; SCHEDULES ; Sensation - physiology ; Sensation - radiation effects ; SYMPTOMS ; Time Factors ; Ultrasonography</subject><ispartof>International journal of radiation oncology, biology, physics, 2012-12, Vol.84 (5), p.e593-e599</ispartof><rights>2012</rights><rights>Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c511t-e8df86a56f1da422d0d85c505f1c6eeee0765a651bc54593a2b94dc820ed96f53</citedby><cites>FETCH-LOGICAL-c511t-e8df86a56f1da422d0d85c505f1c6eeee0765a651bc54593a2b94dc820ed96f53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0360301612008589$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22836050$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22149680$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Yeoh, Eric K., MD, FRCP (Edin), FRCR, FRANZCR</creatorcontrib><creatorcontrib>Holloway, Richard H., MD, FRACP</creatorcontrib><creatorcontrib>Fraser, Robert J., PhD, FRACP</creatorcontrib><creatorcontrib>Botten, Rochelle J., BSc (Hons)</creatorcontrib><creatorcontrib>Di Matteo, Addolorata C., BSc(Hons)</creatorcontrib><creatorcontrib>Butters, Julie, BHSc</creatorcontrib><title>Pathophysiology and Natural History of Anorectal Sequelae Following Radiation Therapy for Carcinoma of the Prostate</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose To characterize the prevalence, pathophysiology, and natural history of chronic radiation proctitis 5 years following radiation therapy (RT) for localized carcinoma of the prostate. Methods and Materials Studies were performed in 34 patients (median age 68 years; range 54-79) previously randomly assigned to either 64 Gy in 32 fractions over 6.4 weeks or 55 Gy in 20 fractions over 4 weeks RT schedule using 2- and later 3-dimensional treatment technique for localized prostate carcinoma. Each patient underwent evaluations of ( 1 ) gastrointestinal (GI) symptoms (Modified Late Effects in Normal Tissues Subjective, Objective, Management and Analytic scales including effect on activities of daily living [ADLs]); ( 2 ) anorectal motor and sensory function (manometry and graded balloon distension); and ( 3 ) anal sphincteric morphology (endoanal ultrasound) before RT, at 1 month, and annually for 5 years after its completion. Results Total GI symptom scores increased after RT and remained above baseline levels at 5 years and were associated with reductions in ( 1 ) basal anal pressures, ( 2 ) responses to squeeze and increased intra-abdominal pressure, ( 3 ) rectal compliance and ( 4 ) rectal volumes of sensory perception. Anal sphincter morphology was unchanged. At 5 years, 44% and 21% of patients reported urgency of defecation and rectal bleeding, respectively, and 48% impairment of ADLs. GI symptom scores and parameters of anorectal function and anal sphincter morphology did not differ between the 2 RT schedules or treatment techniques. Conclusions Five years after RT for prostate carcinoma, anorectal symptoms continue to have a significant impact on ADLs of almost 50% of patients. These symptoms are associated with anorectal dysfunction independent of the RT schedules or treatment techniques reported here.</description><subject>Activities of Daily Living</subject><subject>Aged</subject><subject>Anal Canal - diagnostic imaging</subject><subject>Anal Canal - physiopathology</subject><subject>Anal Canal - radiation effects</subject><subject>BALLOONS</subject><subject>Carcinoma - radiotherapy</subject><subject>CARCINOMAS</subject><subject>EVALUATION</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>MORPHOLOGY</subject><subject>PATIENTS</subject><subject>Pressure</subject><subject>PROCTITIS</subject><subject>Proctitis - etiology</subject><subject>Proctitis - physiopathology</subject><subject>Prospective Studies</subject><subject>PROSTATE</subject><subject>Prostatic Neoplasms - physiopathology</subject><subject>Prostatic Neoplasms - radiotherapy</subject><subject>Radiation Injuries - complications</subject><subject>Radiation Injuries - physiopathology</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>RADIOTHERAPY</subject><subject>Radiotherapy Dosage</subject><subject>RECTUM</subject><subject>Rectum - diagnostic imaging</subject><subject>Rectum - physiopathology</subject><subject>Rectum - radiation effects</subject><subject>Reflex - physiology</subject><subject>Reflex - radiation effects</subject><subject>SCHEDULES</subject><subject>Sensation - physiology</subject><subject>Sensation - radiation effects</subject><subject>SYMPTOMS</subject><subject>Time Factors</subject><subject>Ultrasonography</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNktFr1TAUxoso7m76H4gEfPGlNUmbtH0RxsVtwtDhJvgWcpPTNbU36ZJU6X9vSqcPvmheAsnvnI_vfCfLXhFcEEz4u6Ewg3eHqaCY0ALzApf0SbYjTd3mJWPfnmY7XHKclwk-yU5DGDDGhNTV8-yE0iZ9MbzLwo2MvZv6JRg3uvsFSavRJxlnL0d0ZUJ0fkGuQ-fWeVAxPd7CwwyjBHThxtH9NPYefZHayGicRXc9eDktqHMe7aVXxrqjXOtjD-jGuxBlhBfZs06OAV4-3mfZ14sPd_ur_Prz5cf9-XWuGCExh0Z3DZeMd0TLilKNdcMUw6wjikM6uOZMckYOilWsLSU9tJVWDcWgW96x8ix7s_VNskYEZSKoXjlrkxFBKala3uBEvd2oybvkLERxNEHBOEoLbg6C8KbmPJH_gRJG6jTkctWuNlQl08FDJyZvjtIvgmCx5icGseUn1vwE5iLll8pePyrMhyPoP0W_A0vA-w2ANLgfBvzqC6wCbdZ8hHbmXwp_N1CjsUbJ8TssEAY3e5tCEUSEVCNu1x1aV4hQjBvWtOUv8-_DKA</recordid><startdate>20121201</startdate><enddate>20121201</enddate><creator>Yeoh, Eric K., MD, FRCP (Edin), FRCR, FRANZCR</creator><creator>Holloway, Richard H., MD, FRACP</creator><creator>Fraser, Robert J., PhD, FRACP</creator><creator>Botten, Rochelle J., BSc (Hons)</creator><creator>Di Matteo, Addolorata C., BSc(Hons)</creator><creator>Butters, Julie, BHSc</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7U7</scope><scope>C1K</scope><scope>OTOTI</scope></search><sort><creationdate>20121201</creationdate><title>Pathophysiology and Natural History of Anorectal Sequelae Following Radiation Therapy for Carcinoma of the Prostate</title><author>Yeoh, Eric K., MD, FRCP (Edin), FRCR, FRANZCR ; Holloway, Richard H., MD, FRACP ; Fraser, Robert J., PhD, FRACP ; Botten, Rochelle J., BSc (Hons) ; Di Matteo, Addolorata C., BSc(Hons) ; Butters, Julie, BHSc</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c511t-e8df86a56f1da422d0d85c505f1c6eeee0765a651bc54593a2b94dc820ed96f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Activities of Daily Living</topic><topic>Aged</topic><topic>Anal Canal - diagnostic imaging</topic><topic>Anal Canal - physiopathology</topic><topic>Anal Canal - radiation effects</topic><topic>BALLOONS</topic><topic>Carcinoma - radiotherapy</topic><topic>CARCINOMAS</topic><topic>EVALUATION</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>MORPHOLOGY</topic><topic>PATIENTS</topic><topic>Pressure</topic><topic>PROCTITIS</topic><topic>Proctitis - etiology</topic><topic>Proctitis - physiopathology</topic><topic>Prospective Studies</topic><topic>PROSTATE</topic><topic>Prostatic Neoplasms - physiopathology</topic><topic>Prostatic Neoplasms - radiotherapy</topic><topic>Radiation Injuries - complications</topic><topic>Radiation Injuries - physiopathology</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>RADIOTHERAPY</topic><topic>Radiotherapy Dosage</topic><topic>RECTUM</topic><topic>Rectum - diagnostic imaging</topic><topic>Rectum - physiopathology</topic><topic>Rectum - radiation effects</topic><topic>Reflex - physiology</topic><topic>Reflex - radiation effects</topic><topic>SCHEDULES</topic><topic>Sensation - physiology</topic><topic>Sensation - radiation effects</topic><topic>SYMPTOMS</topic><topic>Time Factors</topic><topic>Ultrasonography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yeoh, Eric K., MD, FRCP (Edin), FRCR, FRANZCR</creatorcontrib><creatorcontrib>Holloway, Richard H., MD, FRACP</creatorcontrib><creatorcontrib>Fraser, Robert J., PhD, FRACP</creatorcontrib><creatorcontrib>Botten, Rochelle J., BSc (Hons)</creatorcontrib><creatorcontrib>Di Matteo, Addolorata C., BSc(Hons)</creatorcontrib><creatorcontrib>Butters, Julie, BHSc</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yeoh, Eric K., MD, FRCP (Edin), FRCR, FRANZCR</au><au>Holloway, Richard H., MD, FRACP</au><au>Fraser, Robert J., PhD, FRACP</au><au>Botten, Rochelle J., BSc (Hons)</au><au>Di Matteo, Addolorata C., BSc(Hons)</au><au>Butters, Julie, BHSc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pathophysiology and Natural History of Anorectal Sequelae Following Radiation Therapy for Carcinoma of the Prostate</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2012-12-01</date><risdate>2012</risdate><volume>84</volume><issue>5</issue><spage>e593</spage><epage>e599</epage><pages>e593-e599</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Purpose To characterize the prevalence, pathophysiology, and natural history of chronic radiation proctitis 5 years following radiation therapy (RT) for localized carcinoma of the prostate. Methods and Materials Studies were performed in 34 patients (median age 68 years; range 54-79) previously randomly assigned to either 64 Gy in 32 fractions over 6.4 weeks or 55 Gy in 20 fractions over 4 weeks RT schedule using 2- and later 3-dimensional treatment technique for localized prostate carcinoma. Each patient underwent evaluations of ( 1 ) gastrointestinal (GI) symptoms (Modified Late Effects in Normal Tissues Subjective, Objective, Management and Analytic scales including effect on activities of daily living [ADLs]); ( 2 ) anorectal motor and sensory function (manometry and graded balloon distension); and ( 3 ) anal sphincteric morphology (endoanal ultrasound) before RT, at 1 month, and annually for 5 years after its completion. Results Total GI symptom scores increased after RT and remained above baseline levels at 5 years and were associated with reductions in ( 1 ) basal anal pressures, ( 2 ) responses to squeeze and increased intra-abdominal pressure, ( 3 ) rectal compliance and ( 4 ) rectal volumes of sensory perception. Anal sphincter morphology was unchanged. At 5 years, 44% and 21% of patients reported urgency of defecation and rectal bleeding, respectively, and 48% impairment of ADLs. GI symptom scores and parameters of anorectal function and anal sphincter morphology did not differ between the 2 RT schedules or treatment techniques. Conclusions Five years after RT for prostate carcinoma, anorectal symptoms continue to have a significant impact on ADLs of almost 50% of patients. These symptoms are associated with anorectal dysfunction independent of the RT schedules or treatment techniques reported here.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>22836050</pmid><doi>10.1016/j.ijrobp.2012.06.032</doi></addata></record> |
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subjects | Activities of Daily Living Aged Anal Canal - diagnostic imaging Anal Canal - physiopathology Anal Canal - radiation effects BALLOONS Carcinoma - radiotherapy CARCINOMAS EVALUATION Hematology, Oncology and Palliative Medicine Humans Male Middle Aged MORPHOLOGY PATIENTS Pressure PROCTITIS Proctitis - etiology Proctitis - physiopathology Prospective Studies PROSTATE Prostatic Neoplasms - physiopathology Prostatic Neoplasms - radiotherapy Radiation Injuries - complications Radiation Injuries - physiopathology Radiology RADIOLOGY AND NUCLEAR MEDICINE RADIOTHERAPY Radiotherapy Dosage RECTUM Rectum - diagnostic imaging Rectum - physiopathology Rectum - radiation effects Reflex - physiology Reflex - radiation effects SCHEDULES Sensation - physiology Sensation - radiation effects SYMPTOMS Time Factors Ultrasonography |
title | Pathophysiology and Natural History of Anorectal Sequelae Following Radiation Therapy for Carcinoma of the Prostate |
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