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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Veröffentlicht in:International journal of radiation oncology, biology, physics biology, physics, 2012-12, Vol.84 (5), p.e593-e599
Hauptverfasser: 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
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container_issue 5
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container_title International journal of radiation oncology, biology, physics
container_volume 84
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. 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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. 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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.</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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