Skip to main content
SpringerLink
Log in

Radiation Proctitis

  • Chapter
  • First Online:
Acute Side Effects of Radiation Therapy

  • 2094 Accesses

Abstract

The rectum is the most affected organ during pelvic radiation therapy because of its fixed position in the central part of pelvic cavity [1]. Acute radiation proctitis occurs in more than 75% of the patients during pelvic radiation therapy [2]. Treatment interruption due to severe acute radiation proctitis has been reported in 10–20% of patients undergoing pelvic radiation therapy [3, 4].

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

Access this chapter

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 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
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

Institutional subscriptions

References

  1. Counter SF, Froese DP, Hart MJ (1999) Prospective evaluation of formalin therapy for radiation proctitis. Am J Surg 177(5):396–398

    Article  CAS  PubMed  Google Scholar 

  2. Grodsky MB, Sidani SM (2015) Radiation proctopathy. Clin Colon Rectal Surg 28(02):103–111

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yeoh E, Russo A, Botten R, Fraser R, Roos D, Penniment M et al (1998) Acute effects of therapeutic irradiation for prostatic carcinoma on anorectal function. Gut 43(1):123–127

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Cotti G, Seid V, Araujo S, Kiss DR, Habr-Gama A (2003) Conservative therapies for hemorrhagic radiation proctitis: a review. Rev Hosp Clin Fac Med Sao Paulo 58(5):284–292

    Article  PubMed  Google Scholar 

  5. Hovdenak N, Fajardo LF, Hauer-Jensen M (2000) Acute radiation proctitis: a sequential clinicopathologic study during pelvic radiotherapy. Int J Radiat Oncol Biol Phys 48(4):1111–1117

    Article  CAS  PubMed  Google Scholar 

  6. Haboubi N, Rowland P, Schofield P (1988) The light and electron microscopic features of early and late phase radiation-induced proctitis. Am J Gastroenterol 83(10):1140–1144

    CAS  PubMed  Google Scholar 

  7. Sedgwick D, Howard G, Ferguson A (1994) Pathogenesis of acute radiation injury to the rectum. Int J Color Dis 9(1):23–30

    Article  CAS  Google Scholar 

  8. Cole A, Slater K, Sokal M, Hawkey C (1993) In vivo rectal inflammatory mediator changes with radiotherapy to the pelvis. Gut 34(9):1210–1214

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Yang TJ, JH O, Son CH, Apte A, Deasy JO, Wu A et al (2013) Predictors of acute gastrointestinal toxicity during pelvic chemoradiotherapy in patients with rectal cancer. Gastrointest Cancer Res 6(5–6):129–136

    PubMed  PubMed Central  Google Scholar 

  10. Valdagni R, Rancati T, Fiorino C, Fellin G, Magli A, Baccolini M et al (2008) Development of a set of nomograms to predict acute lower gastrointestinal toxicity for prostate cancer 3D-CRT. Int J Radiat Oncol Biol Phys 71(4):1065–1073

    Article  PubMed  Google Scholar 

  11. Fuccio L, Frazzoni L, Guido A (2015) Prevention of pelvic radiation disease. World J Gastrointest Pharmacol Ther 6(1):1–9

    Article  PubMed  PubMed Central  Google Scholar 

  12. Peeters ST, Hoogeman MS, Heemsbergen WD, Slot A, Tabak H, Koper PC et al (2005) Volume and hormonal effects for acute side effects of rectum and bladder during conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 63(4):1142–1152

    Article  PubMed  Google Scholar 

  13. Gérard J-P, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon-Dejardin M-T et al (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 24(28):4620–4625

    Article  PubMed  Google Scholar 

  14. Sharma B, Pandey D, Chauhan V, Gupta D, Mokta J, Thakur S (2005) Radiation proctitis. J Indian Acad Clin Med 6:146–151

    Google Scholar 

  15. Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L et al (2008) Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 358(12):1250–1261

    Article  CAS  PubMed  Google Scholar 

  16. Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the radiation therapy oncology group (RTOG) and the European organization for research and treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys 31(5):1341–1346

    Article  CAS  PubMed  Google Scholar 

  17. NCI, NIH, DHHS (2009) Common terminology criteria for adverse events v4. 0. National Cancer Institute, Bethesda, MD

    Google Scholar 

  18. Zelefsky MJ, Fuks Z, Happersett L, Lee HJ, Ling CC, Burman CM et al (2000) Clinical experience with intensity modulated radiation therapy (IMRT) in prostate cancer. Radiother Oncol 55(3):241–249

    Article  CAS  PubMed  Google Scholar 

  19. Lukovic J, Patil N, D’souza D, Millman B, Yaremko BP, Leung E et al (2016) Intensity-modulated radiation therapy versus 3D conformal radiotherapy for postoperative gynecologic cancer: are they covering the same planning target volume? Cureus 8(1):e467

    PubMed  PubMed Central  Google Scholar 

  20. Ahamad A, D’Souza W, Salehpour M, Iyer R, Tucker SL, Jhingran A et al (2005) Intensity-modulated radiation therapy after hysterectomy: comparison with conventional treatment and sensitivity of the normal-tissue–sparing effect to margin size. Int J Radiat Oncol Biol Phys 62(4):1117–1124

    Article  PubMed  Google Scholar 

  21. Yang B, Zhu L, Cheng H, Li Q, Zhang Y, Zhao Y (2012) Dosimetric comparison of intensity modulated radiotherapy and three-dimensional conformal radiotherapy in patients with gynecologic malignancies: a systematic review and meta-analysis. Radiat Oncol 7(1):1

    Article  Google Scholar 

  22. Jabbour SK, Patel S, Herman JM, Wild A, Nagda SN, Altoos T et al (2012) Intensity-modulated radiation therapy for rectal carcinoma can reduce treatment breaks and emergency department visits. Int J Surg Oncol 2012:891067

    PubMed  PubMed Central  Google Scholar 

  23. Sharma NK, Li T, Chen DY, Pollack A, Horwitz EM, Buyyounouski MK (2011) Intensity-modulated radiotherapy reduces gastrointestinal toxicity in patients treated with androgen deprivation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 80(2):437–444

    Article  PubMed  Google Scholar 

  24. Arbea L, Ramos LI, Martínez-Monge R, Moreno M, Aristu J (2010) Intensity-modulated radiation therapy (IMRT) vs. 3D conformal radiotherapy (3DCRT) in locally advanced rectal cancer (LARC): dosimetric comparison and clinical implications. Radiat Oncol 5(1):1

    Article  Google Scholar 

  25. Bazan JG, Hara W, Hsu A, Kunz PA, Ford J, Fisher GA et al (2011) Intensity-modulated radiation therapy versus conventional radiation therapy for squamous cell carcinoma of the anal canal. Cancer 117(15):3342–3351

    Article  PubMed  Google Scholar 

  26. Athanassiou H, Antonadou D, Coliarakis N, Kouveli A, Synodinou M, Paraskevaidis M et al (2003) Protective effect of amifostine during fractionated radiotherapy in patients with pelvic carcinomas: results of a randomized trial. Int J Radiat Oncol Biol Phys 56(4):1154–1160

    Article  CAS  PubMed  Google Scholar 

  27. Peterson D, Boers-Doets C, Bensadoun R, Herrstedt J (2015) Management of oral and gastrointestinal mucosal injury: ESMO clinical practice guidelines for diagnosis, treatment, and follow-up. Ann Oncol 26(Suppl 5):v139–v151

    Article  PubMed  Google Scholar 

  28. Katsanos KH, Briasoulis E, Tsekeris P, Batistatou A, Bai M, Tolis C et al (2010) Randomized phase II exploratory study of prophylactic amifostine in cancer patients who receive radical radiotherapy to the pelvis. J Exp Clin Cancer Res 29(1):1

    Article  Google Scholar 

  29. Singh AK, Ménard C, Guion P, Simone NL, Smith S, Crouse NS et al (2006) Intrarectal amifostine suspension may protect against acute proctitis during radiation therapy for prostate cancer: a pilot study. Int J Radiat Oncol Biol Phys 65(4):1008–1013

    Article  CAS  PubMed  Google Scholar 

  30. Kouloulias VE, Kouvaris JR, Pissakas G, Mallas E, Antypas C, Kokakis JD et al (2005) 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 62(2):486–493

    Article  CAS  PubMed  Google Scholar 

  31. Wilder RB, Barme GA, Gilbert RF, Holevas RE, Kobashi LI, Reed RR et al (2010) Cross-linked hyaluronan gel reduces the acute rectal toxicity of radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 77(3):824–830

    Article  CAS  PubMed  Google Scholar 

  32. Prada PJ, Fernández J, Martinez AA, De La Rua A, Gonzalez JM, Fernandez JM et al (2007) Transperineal injection of hyaluronic acid in anterior perirectal fat to decrease rectal toxicity from radiation delivered with intensity modulated brachytherapy or EBRT for prostate cancer patients. Int J Radiat Oncol Biol Phys 69(1):95–102

    Article  CAS  PubMed  Google Scholar 

  33. Noyes WR, Hosford CC, Schultz SE (2012) Human collagen injections to reduce rectal dose during radiotherapy. Int J Radiat Oncol Biol Phys 82(5):1918–1922

    Article  CAS  PubMed  Google Scholar 

  34. van Lin ENT, Hoffmann AL, van Kollenburg P, Leer JW, Visser AG (2005) Rectal wall sparing effect of three different endorectal balloons in 3D conformal and IMRT prostate radiotherapy. Int J Radiat Oncol Biol Phys 63(2):565–576

    Article  PubMed  Google Scholar 

  35. O’Brien PC, Franklin CI, Dear KB, Hamilton CC, Poulsen M, Joseph DJ et al (1997) A phase III double-blind randomised study of rectal sucralfate suspension in the prevention of acute radiation proctitis. Radiother Oncol 45(2):117–123

    Article  PubMed  Google Scholar 

  36. Kneebone A, Mameghan H, Bolin T, Berry M, Turner S, Kearsley J et al (2001) The effect of oral sucralfate on the acute proctitis associated with prostate radiotherapy: a double-blind, randomized trial. Int J Radiat Oncol Biol Phys 51(3):628–635

    Article  CAS  PubMed  Google Scholar 

  37. Khan AM, Birk JW, Anderson JC, Georgsson M, Park TL, Smith CJ et al (2000) A prospective randomized placebo-controlled double-blinded pilot study of misoprostol rectal suppositories in the prevention of acute and chronic radiation proctitis symptoms in prostate cancer patients. Am J Gastroenterol 95(8):1961–1966

    Article  CAS  PubMed  Google Scholar 

  38. Hille A, Schmidberger H, Hermann RM, Christiansen H, Saile B, Pradier O et al (2005) A phase III randomized, placebo-controlled, double-blind study of misoprostol rectal suppositories to prevent acute radiation proctitis in patients with prostate cancer. Int J Radiat Oncol Biol Phys 63(5):1488–1493

    Article  CAS  PubMed  Google Scholar 

  39. Stefanelli A, Pascale G, Rainieri E, Ursino S, Colella M, Zini G et al (2012) Can we decrease the acute proctitis in prostate cancer patients using hyaluronic acid during radiation therapy: a prospective historically controlled clinical study. Eur Rev Med Pharmacol Sci 16(5):639–645

    CAS  PubMed  Google Scholar 

  40. Pruitt R, Hanson J, Safdi M, Wruble L, Hardi R, Johanson J et al (2002) Balsalazide is superior to mesalamine in the time to improvement of signs and symptoms of acute mild-to-moderate ulcerative colitis. Am J Gastroenterol 97(12):3078–3086

    Article  CAS  PubMed  Google Scholar 

  41. Jahraus CD, Bettenhausen D, Malik U, Sellitti M, Clair WHS (2005) Prevention of acute radiation-induced proctosigmoiditis by balsalazide: a randomized, double-blind, placebo controlled trial in prostate cancer patients. Int J Radiat Oncol Biol Phys 63(5):1483–1487

    Article  CAS  PubMed  Google Scholar 

  42. Freund U, Schölmerich J, Siems H, Kluge F, Schäfer H, Wannenmacher M (1987) Unwanted side-effects in using mesalazine (5-aminosalicylic acid) during radiotherapy. Strahlenther Onkol 163(10):678–680

    CAS  PubMed  Google Scholar 

  43. Fuccio L, Guido A, Laterza L, Eusebi L, Busutti L, Bunkheila F et al (2011) 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 34(6):628–637

    Article  CAS  PubMed  Google Scholar 

  44. Maggio A, Magli A, Rancati T, Fiorino C, Valvo F, Fellin G et al (2014) 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 89(3):518–524

    Article  PubMed  Google Scholar 

  45. Kane SV, Sandborn WJ, Rufo PA, Zholudev A, Boone J, Lyerly D et al (2003) Fecal lactoferrin is a sensitive and specific marker in identifying intestinal inflammation. Am J Gastroenterol 98(6):1309–1314

    Article  CAS  PubMed  Google Scholar 

  46. Erbayrak M, Turkay C, Eraslan E, Cetinkaya H, Kasapoglu B, Bektas M (2009) The role of fecal calprotectin in investigating inflammatory bowel diseases. Clinics 64(5):421–425

    Article  PubMed  PubMed Central  Google Scholar 

  47. Larsen A, Hovdenak N, Karlsdottir A, Wentzel-Larsen T, Dahl O, Fagerhol M (2004) Faecal calprotectin and lactoferrin as markers of acute radiation proctitis: a pilot study of eight stool markers. Scand J Gastroenterol 39(11):1113–1118

    Article  CAS  PubMed  Google Scholar 

  48. Hille A, Schmidt-Giese E, Hermann RM, Herrmann MK, Rave-Fränk M, Schirmer M et al (2008) A prospective study of faecal calprotectin and lactoferrin in the monitoring of acute radiation proctitis in prostate cancer treatment. Scand J Gastroenterol 43(1):52–58

    Article  CAS  PubMed  Google Scholar 

  49. Hille A, Rave-Fränk M, Christiansen H, Herrmann MK, Kertesz T, Hermann RM et al (2009) Faecal calprotectin and lactoferrin values during irradiation of prostate cancer correlate with chronic radiation proctitis: results of a prospective study. Scand J Gastroenterol 44(8):939–946

    Article  CAS  PubMed  Google Scholar 

  50. Hirata I, Hoshimoto M, Saito O, Kayazawa M, Nishikawa T, Murano M et al (2007) Usefulness of fecal lactoferrin and hemoglobin in diagnosis of colorectal diseases. World J Gastroenterol 13(10):1569–1574

    Article  PubMed  PubMed Central  Google Scholar 

  51. Varela E, Antolín M, Guarner F, Verges R, Giralt J, Malagelada JR (2009) Faecal DNA and calprotectin as biomarkers of acute intestinal toxicity in patients undergoing pelvic radiotherapy. Aliment Pharmacol Ther 30(2):175–185

    Article  CAS  PubMed  Google Scholar 

  52. Read M, Read N, Barber D, Duthie H (1982) Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci 27(9):807–814

    Article  CAS  PubMed  Google Scholar 

  53. Halverson AL (2005) Nonoperative management of fecal incontinence. Clin Colon Rectal Surg 18(1):17–21

    Article  PubMed  PubMed Central  Google Scholar 

  54. Hallgren T, Fasth S, Delbro D, Nordgren S, Öresland T, Hulten L (1994) Loperamide improves anal sphincter function and continence after restorative proctocolectomy. Dig Dis Sci 39(12):2612–2618

    Article  CAS  PubMed  Google Scholar 

  55. Weiner JP, Wong AT, Schwartz D, Martinez M, Aytaman A, Schreiber D (2016) Endoscopic and non-endoscopic approaches for the management of radiation-induced rectal bleeding. World J Gastroenterol 22(31):6972–6986

    Article  PubMed  PubMed Central  Google Scholar 

  56. Hille PDA, Herrmann MK, Kertesz T, Christiansen H, Hermann RM, Pradier O et al (2008) Sodium butyrate enemas in the treatment of acute radiation-induced proctitis in patients with prostate cancer and the impact on late proctitis. Strahlenther Onkol 184(12):686–692

    Article  PubMed  Google Scholar 

  57. Vernia P, Fracasso P, Casale V, Villotti G, Marcheggiano A, Stigliano V et al (2000) Topical butyrate for acute radiation proctitis: randomised, crossover trial. Lancet 356(9237):1232–1235

    Article  CAS  PubMed  Google Scholar 

  58. Kochhar R, Patel F, Sharma S, Ayyagari S, Aggarwal R, Goenka M et al (1991) Radiation-induced proctosigmoiditis. Dig Dis Sci 36(1):103–107

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Oncology, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Shahid Madani Street, Tehran, Iran

    Ainaz Sourati & Ahmad Ameri

  2. Department of Radiotherapy and Oncology, Shohadaye Tajrish Educational Hospital Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran

    Mona Malekzadeh

Authors
  1. Ainaz Sourati
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmad Ameri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mona Malekzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Sourati, A., Ameri, A., Malekzadeh, M. (2017). Radiation Proctitis. In: Acute Side Effects of Radiation Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-55950-6_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-55950-6_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-55949-0

  • Online ISBN: 978-3-319-55950-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation