Skip to main content
SpringerLink
Log in
Book cover

Coloproctology pp 51–70Cite as

Colorectal Complications of Radiotherapy

  • Chapter
  • First Online:

  • 591 Accesses

Abstract

Colorectal complications resulting from pelvic radiotherapy may manifest from 3 weeks to over 10 years after treatment. Almost all patients will experience some gastro-intestinal symptoms within in the first 6 weeks after treatment, these are usually self-limiting. They are best managed supportively. Chronic complications occurring after 3 months are moderate to severe in 20–30% of patients, with 5–10% of patients developing serious complications at 10 years. Developments to limit the collateral damage from pelvic radiotherapy to normal tissue have been developed and although a wide range of treatments exist, there remains a need for high quality evidence in the management of colorectal complications from radiotherapy.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Peeters ST, Heemsbergen WD, van Putten WL, Slot A, Tabak H, Mens JW, et al. Acute and late complications after radiotherapy for prostate cancer: results of a multicenter randomized trial comparing 68 Gy to 78 Gy. Int J Radiat Oncol Biol Phys. 2005;61(4):1019–34. PubMed PMID: 15752881

    Article  PubMed  Google Scholar 

  2. Andreyev J. Gastrointestinal symptoms after pelvic radiotherapy: a new understanding to improve management of symptomatic patients. Lancet Oncol. 2007;8(11):1007–17. PubMed PMID: 17976611

    Article  PubMed  Google Scholar 

  3. Fuccio L, Guido A, Andreyev HJ. Management of intestinal complications in patients with pelvic radiation disease. Clin Gastroenterol Hepatol. 2012;10(12):1326–34.e4. PubMed PMID: 22858731.

    Google Scholar 

  4. Herold DM, Hanlon AL, Hanks GE. Diabetes mellitus: a predictor for late radiation morbidity. Int J Radiat Oncol Biol Phys. 1999;43(3):475–9. PubMed PMID: 10078625

    Article  CAS  PubMed  Google Scholar 

  5. Willett CG, Ooi CJ, Zietman AL, Menon V, Goldberg S, Sands BE, et al. Acute and late toxicity of patients with inflammatory bowel disease undergoing irradiation for abdominal and pelvic neoplasms. Int J Radiat Oncol Biol Phys. 2000;46(4):995–8. PubMed PMID: 10705022

    Article  CAS  PubMed  Google Scholar 

  6. Khalid U, McGough C, Hackett C, Blake P, Harrington KJ, Khoo VS, et al. A modified inflammatory bowel disease questionnaire and the Vaizey Incontinence questionnaire are more sensitive measures of acute gastrointestinal toxicity during pelvic radiotherapy than RTOG grading. Int J Radiat Oncol Biol Phys. 2006;64(5):1432–41. PubMed PMID: 16580497

    Article  PubMed  Google Scholar 

  7. Morris KA, Haboubi NY. Pelvic radiation therapy: between delight and disaster. World J Gastrointest Surg. 2015;7(11):279–88. PubMed PMID: 26649150. Pubmed Central PMCID: 4663381

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ganeshan DM, Salem U, Viswanathan C, Balachandran A, Garg N, Silverman P, et al. Complications of oncologic therapy in the abdomen and pelvis: a review. Abdom Imaging. 2013;38(1):1–21. PubMed PMID: 22644726

    Article  PubMed  Google Scholar 

  9. Denton A, Forbes A, Andreyev J, Maher EJ. Non surgical interventions for late radiation proctitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database Syst Rev. 2002;1:CD003455. PubMed PMID: 11869662

    Google Scholar 

  10. Denton AS, Andreyev HJ, Forbes A, Maher EJ. Systematic review for non-surgical interventions for the management of late radiation proctitis. Br J Cancer. 2002;87(2):134–43. PubMed PMID: 12107832. Pubmed Central PMCID: 2376119

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Lesperance RN, Kjorstadt RJ, Halligan JB, Steele SR. Colorectal complications of external beam radiation versus brachytherapy for prostate cancer. Am J Surg. 2008;195(5):616–20. discussion 20. PubMed PMID: 18374892

    Article  PubMed  Google Scholar 

  12. Marks LB, Carroll PR, Dugan TC, Anscher MS. The response of the urinary bladder, urethra, and ureter to radiation and chemotherapy. Int J Radiat Oncol Biol Phys. 1995;31(5):1257–80. PubMed PMID: 7713787

    Article  CAS  PubMed  Google Scholar 

  13. Andreyev J. Gastrointestinal complications of pelvic radiotherapy: are they of any importance? Gut. 2005;54(8):1051–4. PubMed PMID: 16009675. Pubmed Central PMCID: 1774900

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Coia LR, Myerson RJ, Tepper JE. Late effects of radiation therapy on the gastrointestinal tract. Int J Radiat Oncol Biol Phys. 1995;31(5):1213–36. PubMed PMID: 7713784

    Article  CAS  PubMed  Google Scholar 

  15. Brenn T, Fletcher CD. Postradiation vascular proliferations: an increasing problem. Histopathology. 2006;48(1):106–14. PubMed PMID: 16359542

    Article  CAS  PubMed  Google Scholar 

  16. Denham JW, Hauer-Jensen M. The radiotherapeutic injury—a complex ‘wound’. Radiother Oncol. 2002;63(2):129–45. PubMed PMID: 12063002

    Article  PubMed  Google Scholar 

  17. Habr-Gama A, Sabbaga J, Gama-Rodrigues J, Sao Juliao GP, Proscurshim I, Bailao Aguilar P, et al. Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: are we getting closer to anal cancer management? Dis Colon Rectum. 2013;56(10):1109–17. PubMed PMID: 24022527

    Article  PubMed  Google Scholar 

  18. Hauer-Jensen M, Wang J, Denham JW. Bowel injury: current and evolving management strategies. Semin Radiat Oncol. 2003;13(3):357–71. PubMed PMID: 12903023

    PubMed  Google Scholar 

  19. Kuku S, Fragkos C, McCormack M, Forbes A. Radiation-induced bowel injury: the impact of radiotherapy on survivorship after treatment for gynaecological cancers. Br J Cancer. 2013;109(6):1504–12. PubMed PMID: 24002603. Pubmed Central PMCID: 3777000

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Pollack J, Holm T, Cedermark B, Altman D, Holmstrom B, Glimelius B, et al. Late adverse effects of short-course preoperative radiotherapy in rectal cancer. Br J Surg. 2006;93(12):1519–25. PubMed PMID: 17054311

    Article  CAS  PubMed  Google Scholar 

  21. Peeters KC, van de Velde CJ, Leer JW, Martijn H, Junggeburt JM, Kranenbarg EK, et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch colorectal cancer group study. J Clin Oncol. 2005;23(25):6199–206. PubMed PMID: 16135487

    Article  CAS  PubMed  Google Scholar 

  22. Hassan I, Larson DW, Wolff BG, Cima RR, Chua HK, Hahnloser D, et al. Impact of pelvic radiotherapy on morbidity and durability of sphincter preservation after coloanal anastomosis for rectal cancers. Dis Colon Rectum. 2008;51(1):32–7. PubMed PMID: 18030527

    Article  PubMed  Google Scholar 

  23. Dunberger G, Lind H, Steineck G, Waldenstrom AC, Nyberg T, al-Abany M, et al. Fecal incontinence affecting quality of life and social functioning among long-term gynecological cancer survivors. Int J Gynecol Cancer. 2010;20(3):449–60. PubMed PMID: 20375813

    Article  PubMed  Google Scholar 

  24. den Hartog Jager FC, van Haastert M, Batterman JJ, Tytgat GN. The endoscopic spectrum of late radiation damage of the rectosigmoid colon. Endoscopy. 1985;17(6):214–6. PubMed PMID: 4065051

    Article  Google Scholar 

  25. Moore EM, Magrino TJ, Johnstone PA. Rectal bleeding after radiation therapy for prostate cancer: endoscopic evaluation. Radiology. 2000;217(1):215–8. PubMed PMID: 11012447

    Article  CAS  PubMed  Google Scholar 

  26. Wachter S, Gerstner N, Goldner G, Potzi R, Wambersie A, Potter R. Endoscopic scoring of late rectal mucosal damage after conformal radiotherapy for prostatic carcinoma. Radiother Oncol. 2000;54(1):11–9. PubMed PMID: 10719695

    Article  CAS  PubMed  Google Scholar 

  27. Williams HR, Vlavianos P, Blake P, Dearnaley DP, Tait D, Andreyev HJ. The significance of rectal bleeding after pelvic radiotherapy. Aliment Pharmacol Ther. 2005;21(9):1085–90. PubMed PMID: 15854169

    Article  CAS  PubMed  Google Scholar 

  28. Regimbeau JM, Panis Y, Gouzi JL, Fagniez PL, French University Association for Surgical R. Operative and long term results after surgery for chronic radiation enteritis. Am J Surg. 2001;182(3):237–42. PubMed PMID: 11587684

    Article  CAS  PubMed  Google Scholar 

  29. Eifel PJ, Levenback C, Wharton JT, Oswald MJ. Time course and incidence of late complications in patients treated with radiation therapy for FIGO stage IB carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys. 1995;32(5):1289–300. PubMed PMID: 7635768

    Article  CAS  PubMed  Google Scholar 

  30. Kimose HH, Fischer L, Spjeldnaes N, Wara P. Late radiation injury of the colon and rectum. Surgical management and outcome. Dis Colon Rectum. 1989;32(8):684–9. PubMed PMID: 2752855

    Article  CAS  PubMed  Google Scholar 

  31. Holm T, Singnomklao T, Rutqvist LE, Cedermark B. Adjuvant preoperative radiotherapy in patients with rectal carcinoma. Adverse effects during long term follow-up of two randomized trials. Cancer. 1996;78(5):968–76. PubMed PMID: 8780533

    Article  CAS  PubMed  Google Scholar 

  32. Chaturvedi AK, Engels EA, Gilbert ES, Chen BE, Storm H, Lynch CF, et al. Second cancers among 104,760 survivors of cervical cancer: evaluation of long-term risk. J Natl Cancer Inst. 2007;99(21):1634–43. PubMed PMID: 17971527

    Article  PubMed  Google Scholar 

  33. Arnold M, Liu L, Kenter GG, Creutzberg CL, Coebergh JW, Soerjomataram I. Second primary cancers in survivors of cervical cancer in The Netherlands: Implications for prevention and surveillance. Radiother Oncol. 2014;111(3):374–81. PubMed PMID: 24833558

    Article  PubMed  Google Scholar 

  34. Berrington de Gonzalez A, Curtis RE, Kry SF, Gilbert E, Lamart S, Berg CD, et al. Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries. Lancet Oncol. 2011;12(4):353–60. PubMed PMID: 21454129. Pubmed Central PMCID: 3086738

    Article  PubMed  Google Scholar 

  35. Smith-Gagen J, Goodwin 3rd GA, Tay J. Multiple primary tumors following stage II and III rectal cancer in patients receiving radiotherapy, 1998–2010. J Cancer Res Clin Oncol. 2014;140(6):949–55. PubMed PMID: 24663823

    Article  PubMed  Google Scholar 

  36. Wiltink LM, Nout RA, Fiocco M, Meershoek-Klein Kranenbarg E, Jurgenliemk-Schulz IM, Jobsen JJ, et al. No increased risk of second cancer after radiotherapy in patients treated for rectal or endometrial cancer in the randomized TME, PORTEC-1, and PORTEC-2 trials. J Clin Oncol. 2015;33(15):1640–6. PubMed PMID: 25534376

    Article  PubMed  Google Scholar 

  37. Horwich A, Fossa SD, Huddart R, Dearnaley DP, Stenning S, Aresu M, et al. Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma. Br J Cancer. 2014;110(1):256–63. PubMed PMID: 24263066. Pubmed Central PMCID: 3887279

    Article  CAS  PubMed  Google Scholar 

  38. Mehmood Q, Beardwood M, Swindell R, Greenhalgh S, Wareham T, Barraclough L, et al. Insufficiency fractures in patients treated with pelvic radiotherapy and chemotherapy for uterine and cervical cancer. Eur J Cancer Care. 2014;23(1):43–50. PubMed PMID: 23889218

    Article  CAS  Google Scholar 

  39. Henson CC, Burden S, Davidson SE, Lal S. Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy. Cochrane Database Syst Rev. 2013;11:CD009896. PubMed PMID: 24282062

    Google Scholar 

  40. Dearnaley DP, Khoo VS, Norman AR, Meyer L, Nahum A, Tait D, et al. Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomised trial. Lancet. 1999;353(9149):267–72. PubMed PMID: 9929018

    Article  CAS  PubMed  Google Scholar 

  41. Hanks GE, Schultheiss TE, Hunt MA, Epstein B. Factors influencing incidence of acute grade 2 morbidity in conformal and standard radiation treatment of prostate cancer. Int J Radiat Oncol Biol Phys. 1995;31(1):25–9. PubMed PMID: 7995764

    Article  CAS  PubMed  Google Scholar 

  42. Koper PC, Stroom JC, van Putten WL, Korevaar GA, Heijmen BJ, Wijnmaalen A, et al. Acute morbidity reduction using 3DCRT for prostate carcinoma: a randomized study. Int J Radiat Oncol Biol Phys. 1999;43(4):727–34. PubMed PMID: 10098427

    Article  CAS  PubMed  Google Scholar 

  43. Vordermark D, Schwab M, Ness-Dourdoumas R, Sailer M, Flentje M, Koelbl O. Association of anorectal dose-volume histograms and impaired fecal continence after 3D conformal radiotherapy for carcinoma of the prostate. Radiother Oncol. 2003;69(2):209–14. PubMed PMID: 14643960

    Article  PubMed  Google Scholar 

  44. Vuong T, Devic S, Belliveau P, Muanza T, Hegyi G. Contribution of conformal therapy in the treatment of anal canal carcinoma with combined chemotherapy and radiotherapy: results of a phase II study. Int J Radiat Oncol Biol Phys. 2003;56(3):823–31. PubMed PMID: 12788191

    Article  PubMed  Google Scholar 

  45. Kishan AU, Kupelian PA. Late rectal toxicity after low-dose-rate brachytherapy: incidence, predictors, and management of side effects. Brachytherapy. 2015;14(2):148–59. PubMed PMID: 25516492

    Article  PubMed  Google Scholar 

  46. Katsanos KH, Briasoulis E, Tsekeris P, Batistatou A, Bai M, Tolis C, et al. Randomized phase II exploratory study of prophylactic amifostine in cancer patients who receive radical radiotherapy to the pelvis. J Exp Clin Cancer Res. 2010;29:68. PubMed PMID: 20537164. Pubmed Central PMCID: 2903531

    Article  PubMed  PubMed Central  Google Scholar 

  47. Kouloulias VE, Kouvaris JR, Pissakas G, Mallas E, Antypas C, Kokakis JD, et al. Phase II multicenter randomized study of amifostine for prevention of acute radiation rectal toxicity: topical intrarectal versus subcutaneous application. Int J Radiat Oncol Biol Phys. 2005;62(2):486–93. PubMed PMID: 15890591

    Article  CAS  PubMed  Google Scholar 

  48. Singh AK, Menard C, Guion P, Simone NL, Smith S, Crouse NS, et al. Intrarectal amifostine suspension may protect against acute proctitis during radiation therapy for prostate cancer: a pilot study. Int J Radiat Oncol Biol Phys. 2006;65(4):1008–13. PubMed PMID: 16730138

    Article  CAS  PubMed  Google Scholar 

  49. Fuccio L, Guido A, Eusebi LH, Laterza L, Grilli D, Cennamo V, et al. Effects of probiotics for the prevention and treatment of radiation-induced diarrhea. J Clin Gastroenterol. 2009;43(6):506–13. PubMed PMID: 19398930

    Article  CAS  PubMed  Google Scholar 

  50. Sahakitrungruang C, Patiwongpaisarn A, Kanjanasilp P, Malakorn S, Atittharnsakul P. A randomized controlled trial comparing colonic irrigation and oral antibiotics administration versus 4% formalin application for treatment of hemorrhagic radiation proctitis. Dis Colon Rectum. 2012;55(10):1053–8. PubMed PMID: 22965404

    Article  PubMed  Google Scholar 

  51. Cavcic J, Turcic J, Martinac P, Jelincic Z, Zupancic B, Panijan-Pezerovic R, et al. Metronidazole in the treatment of chronic radiation proctitis: clinical trial. Croat Med J. 2000;41(3):314–8. PubMed PMID: 10962052

    CAS  PubMed  Google Scholar 

  52. Fuccio L, Guido A, Laterza L, Eusebi LH, Busutti L, Bunkheila F, et al. Randomised clinical trial: preventive treatment with topical rectal beclomethasone dipropionate reduces post-radiation risk of bleeding in patients irradiated for prostate cancer. Aliment Pharmacol Ther. 2011;34(6):628–37. PubMed PMID: 21790680

    Article  CAS  PubMed  Google Scholar 

  53. Fuccio L, Frazzoni L, Guido A. Prevention of pelvic radiation disease. World J Gastrointest Pharmacol Ther. 2015;6(1):1–9. PubMed PMID: 25664197. Pubmed Central PMCID: 4318744

    Article  PubMed  PubMed Central  Google Scholar 

  54. Martenson Jr JA, Hyland G, Moertel CG, Mailliard JA, O'Fallon JR, Collins RT, et al. Olsalazine is contraindicated during pelvic radiation therapy: results of a double-blind, randomized clinical trial. Int J Radiat Oncol Biol Phys. 1996;35(2):299–303. PubMed PMID: 8635937

    Article  CAS  PubMed  Google Scholar 

  55. Maggio A, Magli A, Rancati T, Fiorino C, Valvo F, Fellin G, et al. Daily sodium butyrate enema for the prevention of radiation proctitis in prostate cancer patients undergoing radical radiation therapy: results of a multicenter randomized placebo-controlled dose-finding phase 2 study. Int J Radiat Oncol Biol Phys. 2014;89(3):518–24. PubMed PMID: 24803033

    Article  PubMed  Google Scholar 

  56. Andreyev HJ, Davidson SE, Gillespie C, Allum WH, Swarbrick E, British Society of Gastroenterology, et al. Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer. Gut. 2012;61(2):179–92. PubMed PMID: 22057051. Pubmed Central PMCID: 3245898

    Article  CAS  PubMed  Google Scholar 

  57. Clarke RE, Tenorio LM, Hussey JR, Toklu AS, Cone DL, Hinojosa JG, et al. Hyperbaric oxygen treatment of chronic refractory radiation proctitis: a randomized and controlled double-blind crossover trial with long-term follow-up. Int J Radiat Oncol Biol Phys. 2008;72(1):134–43. PubMed PMID: 18342453

    Article  CAS  PubMed  Google Scholar 

  58. Bennett MH, Feldmeier J, Hampson N, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst Rev. 2012;5:CD005005. PubMed PMID: 22592699

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK

    Malcolm S. Wilson BSc, MBBS, MD, FRCS & Omer Aziz MBBS, PhD, FRCS

Authors
  1. Malcolm S. Wilson BSc, MBBS, MD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Omer Aziz MBBS, PhD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Malcolm S. Wilson BSc, MBBS, MD, FRCS .

Editor information

Editors and Affiliations

  1. Colorectal Surgery, Singleton Hospital, Swansea, United Kingdom

    John Beynon

  2. Department of Colorectal Surgery, Singleton Hospital, Swansea, United Kingdom

    Dean Anthony Harris

  3. Department of Colorectal Surgery, Singleton Hospital, Swansea, United Kingdom

    Mark Davies

  4. Department of Colorectal Surgery, Singleton Hospital, Swansea, United Kingdom

    Martyn Evans

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Wilson, M.S., Aziz, O. (2017). Colorectal Complications of Radiotherapy. In: Beynon, J., Harris, D., Davies, M., Evans, M. (eds) Coloproctology. Springer, Cham. https://doi.org/10.1007/978-3-319-55957-5_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-55957-5_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-55955-1

  • Online ISBN: 978-3-319-55957-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation