Radiation Proctitis

Abstract

Pelvic radiotherapy (RT) has become a vital component of curative treatment for various pelvic malignancies. The fixed anatomical position of the rectum in the pelvis and the close proximity to the prostate, cervix, and uterus, makes the rectum especially vulner - able to secondary radiation injury resulting in chronic radiation proctitis (CRP). Clinical symptoms associated with CRP are commonly classified by the EORTC/RTOG late radia - tion morbidity scoring system. Rectal bleeding is the most frequent symptom of CRP occurring in 29–89.6% of patients. Endoscopy is essential to determine the extent and severity of CRP as well as to exclude other possible causes of inflammation or malignant disease. Typical endoscopic findings of rectal mucosal damage in the course of radiation- induced proctitis include friable mucosa, rectal mucosal hypervascularity, and telangiec -tases. There is no consensus available for the treatment of CRP, and different modalities present a recurrence rate varying from 10 to 30%. CRP can be managed conservatively, and also includes ablation (formalin enemas, radiofrequency ablation, YAG laser or argon plasma coagulation) as well as some patients require surgery. Although modifications of radiation techniques and doses are continually being studied to decrease the incidence of CRP, trials investigating preventive methods have been disappointing to date . anticoagulants, inflammatory bowel disease, hormonal therapy, collagen vascular disease, atherosclerosis, preexisting inflammatory bowel disease, smoking, pelvic inflammatory con -ditions, previous abdominopelvic surgery and possibly secondary anatomical changes with intraabdominal adhesions leading to immobility of intestinal loops in the radiation field (e.g., hysterectomy), radiation dosages to the lower pelvis >54 the volume of ated, or ataxia-telangiectasia ,