Abstract
Pelvic malignancies comprise 19% and 28% of all malignancies in the female and male, respectively. The majority of gynecologic and urologie pelvic malignancies are treated with radiation therapy either alone or in combination with surgery either as definitive or palliative therapy. The pelvic organs, therefore, are at risk for injury by pelvic radiation. We have reviewed our experience and that of the literature with regard to the incidence of injury associated with pelvic irradiation and give recommendations for management. The most frequent and severe complications occur in association with cystectomy performed for carcinoma of the bladder that has failed definitive radiation therapy and in association with radiotherapeutic and surgical treatment of carcinoma of the cervix. We have found an 11% incidence of bowel injury following planned integrated preoperative radiation followed by cystectomy. In our experience, bowel and urinary complications secondary to external beam radiation or 125 I brachytherapy for definitive treatment of carcinoma of the prostate are very similar. The morbidity of external beam radiation therapy has been reduced using a triple-course fractionated protocol. Rectal ulceration requiring colostomy has occurred in approximately 3% of patients treated with external beam or interstitial 125 I therapy. Surgical correction of rectal fistulas using vascularized flaps has been successful after 125 I injury but has not been possible after external beam injury. Urethral complications associated with definitive external beam radiation therapy for carcinoma of the prostate are most often associated with prior transurethral resection. They can be significantly reduced by withholding initiation of therapy for 4–6 weeks after completion of transurethral resection.
Résumé
Le taux des cancers pelviens est respectivement de 19% chez la femme et de 28% chez l'homme. La majorité des affections néoplasiques pelviennes gynécologiques ou urologiques sont traitées par l'irradiation isolée ou associée à une intervention chirurgicale, qu'il s'agisse de traitement à but curateur ou palliatif. Les organes pelviens sont donc exposés à des lésions radiques. L'expérience des auteurs et la revue générale de la littérature concernant la fréquence des lésions pelviennes secondaires à l'irradiation sont relatées ainsi que les modalités de leur traitement. Les complications les plus fréquentes et les plus sévères sont constatées après la cystectomie pour cancer de la vessie qui a résisté à l'irradiation ou après la cystectomie pratiquée secondairement au cancer du col qui a été traité par l'association irradiation-chirurgie. Le taux des lésions radiques de l'intestin secondaires à l'irradiation suivie de cystectomie atteint 11%. D'après l'expérience des auteurs les complications intestinales et urinaires secondaires à l'irradiation du cancer de la prostate par les rayons X ou par I125 est identique. La morbidité de l'irradiation par les rayons X a été réduite en ayant recours à une irradiation en 3 temps. Chez 3% des malades qui ont été traités par les rayons X ou par l'implantation de I125 on a pu observer une ulcération rectale imposant la constitution d'une colostomie. Le traitement chirurgical de la fistule rectale à l'aide de lambeaux bien vascularisés a été suivie de succès lorsque l'irradiation a été pratiquée par l'I125 mais pas après radiothérapie. Les complications urétrales secondaires au traitement du cancer de la prostate par les rayons X se sont manifestés le plus souvent après tentative de résection transurétrale. Leur nombre peut Être réduit si l'irradiation est pratiquée 4 à 6 semaines après l'irradiation.
Resumen
Las neoplasias malignas de la pelvis comprenden el 19% y el 28% de todos los tumores malignos en la mujer y en el hombre respectivamente. La mayoría de estas neoplasias pélvicas ginecológicas y urológicas son tratadas con irradiación primaria o en combinación con cirugía, bien como terapia definitiva o como terapia paliativa. Esto hace que los órganos pélvicos se encuentren en riesgo de lesión por irradiación pélvica. Hemos revisado nuestra experiencia, así como la publicada en la literatura, en relación a la incidencia de lesiones asociadas con irradiación pélvica, y hacemos recomendaciones sobre su manejo. Las complicaciones más frecuentes y severas ocurren en asociación con cistectomía por carcinoma de la vejiga en que ha fallado la terapia de irradiación definitiva y en asocio del tratamiento radioterapéutico y quirÚrgico del carcinoma del cervix. Hemos hallado una incidencia de 11% de lesión intestinal en el tratamiento integral planeado de irradiación preoperatoria seguida de cistectomía. En nuestra experiencia, las complicaciones intestinales y urinarias secundaria a la irradiación externa o a la terapia con125I para el tratamiento definitivo del carcinoma de la próstata son muy similares. La morbilidad de la irradiación externa ha sido reducida utilizando un protocolo de triple ciclo fraccionado. La ulceración rectal que requirió colostomía se presentó en aproximadamente el 3% de los pacientes tratados con irradiación externa o con terapia con125I. La corrección quirÚrgica de las fístulas rectales utilizando colgajos vascularizados ha sido exitosa en lesiones por125I, pero no ha sido posible en el caso de lesiones por irradiación externa. Las complicaciones uretrales asociadas con terapia defintiiva de irradiación externa para carcinoma de próstata generalmente están asociadas con resecciones transuretrales previas. Estas pueden ser significativamente reducidas demorando la iniciación de la terapia por 4–6 semanas después de la resección transuretral.
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Schellhammer, P.F., Jordan, G.H. & El-Mahdi, A.M. Pelvic complications after interstitial and external beam irradiation of urologic and gynecologic malignancy. World J. Surg. 10, 259–268 (1986). https://doi.org/10.1007/BF01658142
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DOI: https://doi.org/10.1007/BF01658142