Radiation proctitis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rekha, M.D., Mahshid Mir, M.D. [2]

Overview

The symptoms and extent of radiation proctitis are variable and usually develop insidiously. The symptoms depend on the dose and duration of the radiation and how sensitive the bowel is to radiation. Common complications of radiation proctitis include intestinal obstruction due to stricture, fecal incontinence due to overflow and fistula formation due to concomitant injury to nearby organs. The prognosis of radiation colitis varies with the sub-type, severity, duration and responsiveness to treatment.

Natural History, Complications and Prognosis

Natural History

• The symptoms and extent of radiation proctitis are variable and usually develop insidiously. The symptoms depend on the dose and duration of the radiation and how sensitive the bowel is to radiation.
• In acute radiation proctitis symptoms usually start shortly after commencement of radiation therapy and progress reaching a peak within 6 weeks.In most cases, the symptoms of acute radiation colitis are self-limiting however up to 20 percent of patients with acute radiation proctitis will have symptoms that are severe enough to require an interruption in radiation treatment.
• The chronic radiation proctitis has delayed onset and symptoms often become noticeable months to years after the completion of radiotherapy. The symptoms may occasionally follow acute radiation colitis. However, previous acute radiation colitis does not increase the risk of a patient developing chronic radiation colitis. Also, absence of acute radiation colitis, does not prevent chronic radiation colitis from occurring. Treatment is required for chronic radiation colitis because resolution of the symptoms is uncommon without intervention.

Complications

Common complications of chronic radiation proctitis include:

• Anemia
• Intestinal obstruction due to stricture
• Fistula
• Fecal incontinence due to overflow
• Malabsorption
• Failure to thrive
• Sepsis, due to loss of the mucosal protective barrier
• Concomitant injury to the genitourinary tract or small bowel may lead to intestinal obstruction, small intestinal bacterial overgrowth, urethral stenosis, and cystitis.

• Risk of development of the secondary malignancy

Prognosis

The prognosis of radiation colitis varies with the sub-type, severity, duration and responsiveness to treatment.

• Acute radiation colitis is usually self-limiting, with resolution of symptoms few weeks after cessation of radiotherapy.
• Chronic radiation colitis is progressive and difficult to manage. The patients may develop secondary radiation-associated malignancy which has a poor prognosis due to late diagnosis.