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Rectal bleeding and its management after irradiation for uterine cervical cancer.

Authors
Chun, M; Kang, S; Kil, HJ; Oh, YT; Sohn, JH; Ryu, HS
Citation
International journal of radiation oncology, biology, physics, 58(1):98-105, 2004
Journal Title
International journal of radiation oncology, biology, physics
ISSN
0360-30161879-355X
Abstract
PURPOSE: To present an evaluation of the risk factors of radiation-induced rectal bleeding and discuss its optimal management in patients with cancer of the cervix.



METHODS AND MATERIALS: A total of 213 patients treated with radiotherapy (RT) alone were included. All patients underwent external beam radiotherapy with high-dose-rate brachytherapy. The rectal dose was calculated by both the International Commission on Radiation Units and Measurements (ICRU) Report 38 guidelines and the anterior rectal wall point on radiographs. Rectal bleeding was scored using the late effects normal tissue-subjective, objective, management, and analytic criteria.



RESULTS: The incidence was 12.7% (27 of 213; Grade 1 in 9, Grade 2 in 16, and Grade 3 in 2). Most (92.6%) developed rectal bleeding within 2 years after RT completion (median 16 months). In univariate analysis, three significant factors were found: ICRU cumulative rectal biologically equivalent dose (CRBED) >100 Gy (19.7% vs. 4.2%), external beam RT dose to the parametrium >55 Gy (22.1% vs. 5.1%), and advanced stage (III-IV; 31.8% vs. 10.5%). In multivariate analysis, the ICRU-CRBED was the only significant factor. Six patients with Grade 1 bleeding experienced immediate relief with sucralfate enema for 1 month. For Grade 2 bleeding, sucralfate enema and/or coagulation were effective. Grade 3 bleeding lasted for 1 year despite frequent transfusions and coagulation.



CONCLUSION: Grade 2 and 3 rectal bleeding occurred in 8.5% of patients. The most significant risk factor was the ICRU-CRBED. Prompt treatment with a combination of sucralfate enema and coagulation was effective in controlling Grade 1 and 2 rectal bleeding without the development of fistula or stricture.
MeSH terms
AdultAgedAged, 80 and overAnalysis of VarianceAnti-Ulcer Agents/therapeutic useFemaleGastrointestinal Hemorrhage/etiology/*therapyHumansMiddle AgedRadiation DosageRadiation Injuries/complications/*therapyRadiation Protection/methodsRectal Diseases/etiology/*therapyRectumRisk FactorsSucralfate/therapeutic useUterine Cervical Neoplasms/*radiotherapy
PMID
14697426
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Radiation Oncology
Journal Papers > School of Medicine / Graduate School of Medicine > Obstetrics & Gynecology
AJOU Authors
전, 미선강, 승희오, 영택유, 희석
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