Advertisement

Journal of Cancer Survivorship

, Volume 10, Issue 2, pp 351–362 | Cite as

Effects of radiation therapy on the structure and function of the pelvic floor muscles of patients with cancer in the pelvic area: a systematic review

  • Stéphanie BernardEmail author
  • Marie-Pier Ouellet
  • Hélène Moffet
  • Jean-Sébastien Roy
  • Chantale Dumoulin
Review

Abstract

Purpose

Radiation therapy (RT) is often recommended in the treatment of pelvic cancers. Following RT, a high prevalence of pelvic floor dysfunctions (urinary incontinence, dyspareunia, and fecal incontinence) is reported. However, changes in pelvic floor muscles (PFMs) after RT remain unclear. The purpose of this review was to systematically document the effects of RT on the PFM structure and function in patients with cancer in the pelvic area.

Methods

An electronic literature search using Pubmed Central, CINAHL, Embase, and SCOPUS was performed from date of inception up to June 2014. The following keywords were used: radiotherapy, muscle tissue, and pelvic floor. Two reviewers selected the studies in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). Out of the 369 articles screened, 13 met all eligibility criteria. The methodological quality was assessed using the QualSyst scoring system, and standardized mean differences were calculated.

Results

Thirteen studies fulfilled all inclusion criteria, from which four were of good methodological quality. One presented strong evidence that RT affects PFM structure in men treated for prostate cancer. Four presented high-level evidence that RT affects PFM function in patients treated for rectal cancer. Meta-analysis was not possible due to heterogeneity and lack of descriptive statistics.

Conclusion

There is some evidence that RT has detrimental impacts on both PFMs’ structure and function.

Implications for cancer survivors

A better understanding of muscle damage and dysfunction following RT treatment will improve pelvic floor rehabilitation and, potentially, prevention of its detrimental impacts.

Keywords

Literature review Pelvic cancer Radiation therapy Pelvic floor disorders Pelvic floor muscles Cancer survivorship 

Notes

Acknowledgments

Stephanie Bernard was supported by scholarships from the Canadian Institutes of Health Research, the Ordre professionnel de la physiothérapie du Québec, and the Centre for Interdisciplinary Research in Rehabilitation and Social Integration.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Comité consultatif de la société canadienne du cancer. Statistiques canadiennes sur le cancer 2013. Toronto (Ontario) Canada: Société canadienne du cancer; 2013.Google Scholar
  2. 2.
  3. 3.
    Bergmark K, Avall-Lundqvist E, Dickman PW, Henningsohn L, Steineck G. Vaginal changes and sexuality in women with a history of cervical cancer. N Engl J Med. 1999;340(18):1383–9. doi: 10.1056/NEJM199905063401802.CrossRefPubMedGoogle Scholar
  4. 4.
    Donovan KA, Boyington AR, Judson PL, Wyman JF. Bladder and bowel symptoms in cervical and endometrial cancer survivors. Psycho-Oncology. 2014;23(6):672–8. doi: 10.1002/pon.3461.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Baratiny G, Chiarelli P. Symptoms of lower urinary tract symptoms after prostate cancer treatment. Neurourol Urodyn. 2011;30(6):896–7.Google Scholar
  6. 6.
    Sadovsky R, Basson R, Krychman M, Morales AM, Schover L, Wang R, et al. Cancer and sexual problems. J Sex Med. 2010;7(1 Pt 2):349–73. doi: 10.1111/j.1743-6109.2009.01620.x.CrossRefPubMedGoogle Scholar
  7. 7.
    Alder J, Bitzer J. Gynecological cancer and sexuality. Ther Umsch. 2011;68(10):581–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Haab F, Beley S, Cornu JN, Culine S, Cussenot O, Hennequin C. Urinary and sexual disorders following localised prostate cancer management. Bull Cancer. 2010;97(12):1537–49.PubMedGoogle Scholar
  9. 9.
    Rutledge TL, Heckman SR, Qualls C, Muller CY, Rogers RG. Pelvic floor disorders and sexual function in gynecologic cancer survivors: a cohort study. Am J Obstet Gynecol. 2010;203(5):514 e1–7. doi: 10.1016/j.ajog.2010.08.004.CrossRefPubMedGoogle Scholar
  10. 10.
    Putta S, Andreyev HJN. Faecal incontinence: a late side-effect of pelvic radiotherapy. Clin Oncol. 2005;17(6):469–77.CrossRefGoogle Scholar
  11. 11.
    Bergmark K, Avall-Lundqvist E, Dickman PW, Henningsohn L, Steineck G. Patient-rating of distressful symptoms after treatment for early cervical cancer. Acta Obstet Gynecol Scand. 2002;81(5):443–50.CrossRefPubMedGoogle Scholar
  12. 12.
    Le T, Menard C, Samant R, Choan E, Hopkins L, Faught W, et al. Longitudinal assessments of quality of life in endometrial cancer patients: effect of surgical approach and adjuvant radiotherapy. Int J Radiat Oncol Biol Phys. 2009;75(3):795–802. doi: 10.1016/j.ijrobp.2008.11.018.CrossRefPubMedGoogle Scholar
  13. 13.
    Ashton-Miller JA, DeLancey JOL. Functional anatomy of the female pelvic floor. In: Bo K, Berghmans B, Morkved S, Van Kampen M, editors. Evidence-based physical therapy for the pelvic floor. 2007. p. 19-33.Google Scholar
  14. 14.
    Raizada V, Mittal RK. Pelvic floor anatomy and applied physiology. Gastroenterol Clin N Am. 2008;37(3):493–509. doi: 10.1016/j.gtc.2008.06.003. vii.CrossRefGoogle Scholar
  15. 15.
    Moore K, Dumoulin C, Bradley C, Burgio K, Chambers T, Hagen S, et al. Adult conservative management. In: Paul Abrams LC, Saad K, Alan W, editors. Incontinence. Paris: Health Publication Ltd; 2013. p. 1101–228.Google Scholar
  16. 16.
    Rutledge TL, Rogers R, Lee SJ, Muller CY. A pilot randomized control trial to evaluate pelvic floor muscle training for urinary incontinence among gynecologic cancer survivors. Gynecol Oncol. 2014;132(1):154–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Yang EJ, Lim JY, Rah UW, Kim YB. Effect of a pelvic floor muscle training program on gynecologic cancer survivors with pelvic floor dysfunction: a randomized controlled trial. Gynecol Oncol. 2012;125(3):705–11.CrossRefPubMedGoogle Scholar
  18. 18.
    Ooi BS, Tjandra JJ, Green MD. Morbidities of adjuvant chemotherapy and radiotherapy for resectable rectal cancer: an overview. Dis Colon Rectum. 1999;42(3):403–18.CrossRefPubMedGoogle Scholar
  19. 19.
    World Health Organization. How to use the ICF: a practical manual for using the International Classification of Functioning, Disability and Health (ICF). (ICF). Exposure draft for comment. Geneva: WHO; 2013.Google Scholar
  20. 20.
    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Nout RA, van de Poll-Franse LV, Lybeert ML, Warlam-Rodenhuis CC, Jobsen JJ, Mens JW, et al. Long-term outcome and quality of life of patients with endometrial carcinoma treated with or without pelvic radiotherapy in the post operative radiation therapy in endometrial carcinoma 1 (PORTEC-1) trial. J Clin Oncol : Off J Am Soc Clin Oncol. 2011;29(13):1692–700. doi: 10.1200/JCO.2010.32.4590.CrossRefGoogle Scholar
  22. 22.
    Berek J, Hacker N. Berek & Hacker’s gynecologic oncology. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2010.Google Scholar
  23. 23.
    Michalski JM, Lawton C, El Naqa I, Ritter M, O’Meara E, Seider MJ, et al. Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2010;76(2):361–8.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Michalski J, Moughan J, Purdy J, al. e. Randomized trial of 79.2Gy versus 70.2Gy radiation therapy (RT) for localized prostate cancer. J Clin Oncol : Off J Am Soc Clin Oncol. 2015;33((suppl 7; abstr 4)).Google Scholar
  25. 25.
    Kmet LM, Lee RC, Cook LS. Standard quality assessment for evaluating primary research papers from a variety of fields. HTA initiative 1706–7855; #13. Edmonton: Heritage Foundation for Medical Research; 2004.Google Scholar
  26. 26.
    Nakagawa S, Cuthill IC. Effect size, confidence interval and statistical significance: a practical guide for biologists. Biol Rev Camb Philos Soc. 2007;82(4):591–605. doi: 10.1111/j.1469-185X.2007.00027.x.CrossRefPubMedGoogle Scholar
  27. 27.
    Cohen J. Statistical power analysis for the behavioral sciences. Routledge Academic; 2013Google Scholar
  28. 28.
    Allgayer H, Dietrich CF, Rohde W, Koch GF, Tuschhoff T. Prospective comparison of short- and long-term effects of pelvic floor exercise/biofeedback training in patients with fecal incontinence after surgery plus irradiation versus surgery alone for colorectal cancer: clinical, functional and endoscopic/endosonographic findings. Scand J Gastroenterol. 2005;40(10):1168–75. doi: 10.1080/00365520510023477.CrossRefPubMedGoogle Scholar
  29. 29.
    Vordermark D, Sailer M, Flentje M, Thiede A, Kolbl O. Curative-intent radiation therapy in anal carcinoma: quality of life and sphincter function. Radiother Oncol. 1999;52(3):239–43.CrossRefPubMedGoogle Scholar
  30. 30.
    Yeoh E, Sun WM, Russo A, Ibanez L, Horowitz M. A retrospective study of the effects of pelvic irradiation for gynecological cancer on anorectal function. Int J Radiat Oncol Biol Phys. 1996;35(5):1003–10. doi: 10.1016/0360-3016(96)00147-2.CrossRefPubMedGoogle Scholar
  31. 31.
    Gervaz P, Hennig R, Buechler M, Soravia C, Brigstock DR, Morel P, et al. Long-term expression of fibrogenic cytokines in radiation-induced damage to the internal anal sphincter. Swiss Surg. 2003;9(4):193–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Marigliano C, Donati OF, Vargas HA, Akin O, Goldman DA, Eastham JA, et al. MRI findings of radiation-induced changes in the urethra and periurethral tissues after treatment for prostate cancer. Eur J Radiol. 2013;82(12):e775–81.CrossRefPubMedGoogle Scholar
  33. 33.
    Yeoh EK, Russo A, Botten R, Fraser R, Roos D, Penniment M, et al. Acute effects of therapeutic irradiation for prostatic carcinoma on anorectal function. Gut. 1998;43(1):123–7.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Yeoh EEK, Botten R, Russo A, McGowan R, Fraser R, Roos D, et al. Chronic effects of therapeutic irradiation for localized prostatic carcinoma on anorectal function. Int J Radiat Oncol Biol Phys. 2000;47(4):915–24. doi: 10.1016/S0360-3016(00)00487-9.CrossRefPubMedGoogle Scholar
  35. 35.
    Coakley FV, Hricak H, Wefer AE, Speight JL, Kurhanewicz J, Roach IM. Brachytherapy for prostate cancer: endorectal MR imaging of local treatment-related changes. Radiology. 2001;219(3):817–21.CrossRefPubMedGoogle Scholar
  36. 36.
    de Noronha AF, de Figueiredo EM, de Figueiredo Franco TMR, Candido EB, Silva-Filho AL. Treatments for invasive carcinoma of the cervix: what are their impacts on the pelvic floor functions? Int Braz J Urol. 2013;39(1):46–54.CrossRefPubMedGoogle Scholar
  37. 37.
    Lorenzi B, Brading AF, Martellucci J, Cetta F, Mortensen NJ. Short-term effects of neoadjuvant chemoradiotherapy on internal anal sphincter function: a human in vitro study. Dis Colon Rectum. 2012;55(4):465–72. doi: 10.1097/DCR.0b013e31824154a0.CrossRefPubMedGoogle Scholar
  38. 38.
    Dieperink KB, Johansen C, Hansen S, Wagner L, Andersen KK, Minet LR, et al. The effects of multidisciplinary rehabilitation: RePCa—a randomised study among primary prostate cancer patients. Br J Cancer. 2013;109(12):3005–13.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Lim JF, Tjandra JJ, Hiscock R, Chao MWT, Gibbs P. Preoperative chemoradiation for rectal cancer causes prolonged pudendal nerve terminal motor latency. Dis Colon Rectum. 2006;49(1):12–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Theisen J, Kauer WK, Nekarda H, Schmid L, Stein HJ, Siewert JR. Neoadjuvant radiochemotherapy for patients with locally advanced rectal cancer leads to impairment of the anal sphincter. J Gastrointest Surg. 2006;10(2):309–14. doi: 10.1016/j.gassur.2005.04.001.CrossRefPubMedGoogle Scholar
  41. 41.
    Morin M, Bourbonnais D, Gravel D, Dumoulin C, Lemieux MC. Pelvic floor muscle function in continent and stress urinary incontinent women using dynamometric measurements. Neurourol Urodyn. 2004;23(7):668–74. doi: 10.1002/nau.20069.CrossRefPubMedGoogle Scholar
  42. 42.
    Howick J, Chalmers I, Glasziou P, Greenhalgh T, Heneghan C, Liberati A et al. The 2011 Oxford CEBM evidence levels of evidence (Introductory Document). Oxford Centre for Evidence-Based Medicine. 2011: http://www.cebm.net/index.aspx?o=5653.
  43. 43.
    Tunn R, Delancey JO, Howard D, Ashton-Miller JA, Quint LE. Anatomic variations in the levator ani muscle, endopelvic fascia, and urethra in nulliparas evaluated by magnetic resonance imaging. Am J Obstet Gynecol. 2003;188(1):116–21.CrossRefPubMedGoogle Scholar
  44. 44.
    Strohbehn K, Ellis JH, Strohbehn JA, DeLancey JO. Magnetic resonance imaging of the levator ani with anatomic correlation. Obstet Gynecol. 1996;87(2):277–85.CrossRefPubMedGoogle Scholar
  45. 45.
    Kirschner-Hermanns R, Anding R, Stief CG, Najjari L, Bauer RM. Imaging diagnostics of the male pelvic floor. Der Urologe Ausg A. 2013;52(4):527–32. doi: 10.1007/s00120-013-3142-4.CrossRefPubMedGoogle Scholar
  46. 46.
    Avery MD. Current resources for evidence-based practice, March/April 2014. J Midwifery Women’s Health. 2014;59(2):210–5.CrossRefGoogle Scholar
  47. 47.
    Smeenk RJ, Hoffmann AL, Hopman WP, van Lin EN, Kaanders JH. Dose-effect relationships for individual pelvic floor muscles and anorectal complaints after prostate radiotherapy. Int J Radiat Oncol Biol Phys. 2012;83(2):636–44. doi: 10.1016/j.ijrobp.2011.08.007.CrossRefPubMedGoogle Scholar
  48. 48.
    Freys SM, Fuchs KH, Fein M, Heimbucher J, Sailer M, Thiede A. Inter- and intraindividual reproducibility of anorectal manometry. Langenbeck’s Arch Surg. 1998;383(5):325–9.CrossRefGoogle Scholar
  49. 49.
    Krol R, Smeenk RJ, van Lin EN, Yeoh EE, Hopman WP. Systematic review: anal and rectal changes after radiotherapy for prostate cancer. Int J Color Dis. 2014;29(3):273–83. doi: 10.1007/s00384-013-1784-8.CrossRefGoogle Scholar
  50. 50.
    Lam TJ, Mulder CJ, Felt-Bersma RJ. Critical reappraisal of anorectal function tests in patients with faecal incontinence who have failed conservative treatment. Int J Color Dis. 2012;27(7):931–7. doi: 10.1007/s00384-012-1415-9.CrossRefGoogle Scholar
  51. 51.
    Bo K, Finckenhagen HB. Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet Gynecol Scand. 2001;80(10):883–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Jensen PT, Groenvold M, Klee MC, Thranov I, Petersen MA, Machin D. Early-stage cervical carcinoma, radical hysterectomy, and sexual function. A longitudinal study. Cancer. 2004;100(1):97–106. doi: 10.1002/cncr.11877.CrossRefPubMedGoogle Scholar
  53. 53.
    Nout RA, Putter H, Jurgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, van der Steen-Banasik EM, et al. Five-year quality of life of endometrial cancer patients treated in the randomised Post Operative Radiation Therapy in Endometrial Cancer (PORTEC-2) trial and comparison with norm data. Eur J Cancer. 2012;48(11):1638–48. doi: 10.1016/j.ejca.2011.11.014.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Stéphanie Bernard
    • 1
    • 2
  • Marie-Pier Ouellet
    • 1
    • 3
  • Hélène Moffet
    • 1
    • 2
  • Jean-Sébastien Roy
    • 1
    • 2
  • Chantale Dumoulin
    • 4
  1. 1.Faculty of MedicineUniversité LavalQuébecCanada
  2. 2.Center for Interdisciplinary Research in Rehabilitation and Social IntegrationQuébecCanada
  3. 3.Centre hospitalier universitaire de QuébecQuébecCanada
  4. 4.Faculté de médecineUniversité de Montréal Centre de Recherche de l’Institut Universitaire de Gériatrie de MontréalMontréalCanada

Personalised recommendations