Clinical Features and Management of Acute and Chronic Radiation-Induced Colitis and Proctopathy

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2023 Jun 28

PMID 37370770

Authors

Hamzah Abu-Sbeih

Tenglong Tang

Faisal S Ali

Weijie Ma

Malek Shatila

Wenyi Luo

Dongfeng Tan

Chad Tang

David M Richards

Phillip S Ge

Anusha S Thomas

Yinghong Wang

Affiliations

Soon will be listed here.

Abstract

Background: RICAP is a recognized adverse effect of radiation therapy (RT) that can adversely affect cancer patients' quality of life. Data on the clinical characteristics and outcomes of RICAP are scarce. We aimed to analyze the clinical and endoscopic characteristics of acute or chronic radiation-induced colitis and proctopathy (ARICAP and CRICAP) based on symptom onset after RT (≤ or >45 days, respectively).

Methods: This is a retrospective observational study of a single tertiary cancer center, from January 2010 and December 2018, of cancer patients with endoscopically confirmed ARICAP and CRICAP. We conducted univariate and multivariate logistic regression analyses to associate clinical variables with endoscopic and medical outcomes.

Results: One hundred and twelve patients were included (84% Caucasian; 55% female; median age of 59 years); 46% had ARICAP with non-bloody diarrhea as the predominant symptom, whereas 55% had CRICAP with mostly bloody diarrhea. Neovascularization was the most frequent finding on endoscopy, followed by bleeding. ARICAP patients more often received medical management ( < 0.001), whereas CRICAP patients with bleeding more often received argon plasma coagulation (APC) ( = 0.002). Female sex and undergoing less-intense RT treatments were more associated with medical treatment; bleeding clinically and during the endoscopy was more associated with APC treatment. However, APC treatment did not significantly reduce bleeding recurrence or RICAP symptoms.

Conclusion: Patients with ARICAP and CRICAP experience different symptoms. Medical management should be considered before endoscopic therapy. APC may be useful in patients with endoscopically apparent bleeding.

References

Coia L, Myerson R, Tepper J . Late effects of radiation therapy on the gastrointestinal tract. Int J Radiat Oncol Biol Phys. 1995; 31(5):1213-36. DOI: 10.1016/0360-3016(94)00419-L. View

Abu-Sbeih H, Ali F, Luo W, Qiao W, Raju G, Wang Y . Importance of endoscopic and histological evaluation in the management of immune checkpoint inhibitor-induced colitis. J Immunother Cancer. 2018; 6(1):95. PMC: 6156850. DOI: 10.1186/s40425-018-0411-1. View

Lee J, Agrawal D, Thosani N, Al-Haddad M, Buxbaum J, Calderwood A . ASGE guideline on the role of endoscopy for bleeding from chronic radiation proctopathy. Gastrointest Endosc. 2019; 90(2):171-182.e1. DOI: 10.1016/j.gie.2019.04.234. View

Waye J . Comment on: Fujii T, Hasegawa RT, Sitoh Y et al. Chromoscopy during colonoscopy. Endoscopy 2001; 33:1036-1041. Endoscopy. 2002; 34(1):92. View

Weiner J, Wong A, Schwartz D, Martinez M, Aytaman A, Schreiber D . Endoscopic and non-endoscopic approaches for the management of radiation-induced rectal bleeding. World J Gastroenterol. 2016; 22(31):6972-86. PMC: 4988305. DOI: 10.3748/wjg.v22.i31.6972. View

Tabaja L, Sidani S . Management of Radiation Proctitis. Dig Dis Sci. 2018; 63(9):2180-2188. DOI: 10.1007/s10620-018-5163-8. View

Kochhar R, Patel F, Dhar A, Sharma S, Ayyagari S, Aggarwal R . Radiation-induced proctosigmoiditis. Prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate. Dig Dis Sci. 1991; 36(1):103-7. DOI: 10.1007/BF01300096. View

Wachsberger P, Burd R, Dicker A . Tumor response to ionizing radiation combined with antiangiogenesis or vascular targeting agents: exploring mechanisms of interaction. Clin Cancer Res. 2003; 9(6):1957-71. View

Wang Y, Wiesnoski D, Helmink B, Gopalakrishnan V, Choi K, DuPont H . Fecal microbiota transplantation for refractory immune checkpoint inhibitor-associated colitis. Nat Med. 2018; 24(12):1804-1808. PMC: 6322556. DOI: 10.1038/s41591-018-0238-9. View

10.

Eifel P, Levenback C, Wharton J, Oswald M . 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. DOI: 10.1016/0360-3016(95)00118-I. View

11.

Stockdale A, Biswas A . Long-term control of radiation proctitis following treatment with sucralfate enemas. Br J Surg. 1997; 84(3):379. DOI: 10.1046/j.1365-2168.1997.02587.x. View

12.

Willett C, Ooi C, Zietman A, Menon V, Goldberg S, Sands B . 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. DOI: 10.1016/s0360-3016(99)00374-0. View

13.

Paquette I, Vogel J, Abbas M, Feingold D, Steele S . The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Chronic Radiation Proctitis. Dis Colon Rectum. 2018; 61(10):1135-1140. DOI: 10.1097/DCR.0000000000001209. View

14.

Morris M, Tucker R, Baron T, Wong Kee Song L . Electrosurgery in gastrointestinal endoscopy: principles to practice. Am J Gastroenterol. 2009; 104(6):1563-74. DOI: 10.1038/ajg.2009.105. View

15.

Ma C, Zhao J, Gan G, He X, Xu X, Qin S . Establishment of a prediction model for severe acute radiation enteritis associated with cervical cancer radiotherapy. World J Gastroenterol. 2023; 29(8):1344-1358. PMC: 10011961. DOI: 10.3748/wjg.v29.i8.1344. View

16.

TALLEY N, Chen F, King D, Jones M, Talley N . Short-chain fatty acids in the treatment of radiation proctitis: a randomized, double-blind, placebo-controlled, cross-over pilot trial. Dis Colon Rectum. 1997; 40(9):1046-50. DOI: 10.1007/BF02050927. View

17.

Sarin A, Safar B . Management of radiation proctitis. Gastroenterol Clin North Am. 2013; 42(4):913-25. DOI: 10.1016/j.gtc.2013.08.004. View

18.

Ding X, Li Q, Li P, Chen X, Xiang L, Bi L . Fecal microbiota transplantation: A promising treatment for radiation enteritis?. Radiother Oncol. 2020; 143:12-18. DOI: 10.1016/j.radonc.2020.01.011. View

19.

Tagkalidis P, Tjandra J . Chronic radiation proctitis. ANZ J Surg. 2001; 71(4):230-7. DOI: 10.1046/j.1440-1622.2001.02081.x. View

20.

Ma T, Yuan Z, Zhong Q, Wang H, Qin Q, Chen X . Formalin irrigation for hemorrhagic chronic radiation proctitis. World J Gastroenterol. 2015; 21(12):3593-8. PMC: 4375582. DOI: 10.3748/wjg.v21.i12.3593. View