Clinical Endoscopy

  • 제55권1호
  • /
  • Pages.22-32
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  • 2022
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  • 2234-2400(pISSN)
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  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
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Radiation Proctitis and Management Strategies

  • Dushyant Singh Dahiya (Department of Internal Medicine, Central Michigan University) ;
  • Asim Kichloo (Department of Internal Medicine, Central Michigan University) ;
  • Faiz Tuma (Department of Surgery, Central Michigan University) ;
  • Michael Albosta (Department of Internal Medicine, Central Michigan University) ;
  • Farah Wani (Department of Family Medicine, Samaritan Medical Center)
  • 투고 : 2020.11.03
  • 심사 : 2021.01.30
  • 발행 : 2022.01.30
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초록

Radiotherapy (RT) is a treatment modality that uses high-energy rays or radioactive agents to generate ionizing radiation against rapidly dividing cells. The main objective of using radiation in cancer therapy is to impair or halt the division of the tumor cells. Over the past few decades, advancements in technology, the introduction of newer methods of RT, and a better understanding of the pathophysiology of cancers have enabled physicians to deliver doses of radiation that match the exact dimensions of the tumor for greater efficacy, with minimal exposure of the surrounding tissues. However, RT has numerous complications, the most common being radiation proctitis (RP). It is characterized by damage to the rectal epithelium by secondary ionizing radiation. Based on the onset of signs and symptoms, post-radiotherapy RP can be classified as acute or chronic, each with varying levels of severity and complication rates. The treatment options available for RP are limited, with most of the data on treatment available from case reports or small studies. Here, we describe the types of RT used in modern-day medicine and radiation-mediated tissue injury. We have primarily focused on the classification, epidemiology, pathogenesis, clinical features, treatment strategies, complications, and prognosis of RP.

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참고문헌

  1. Gianfaldoni S, Gianfaldoni R, Wollina U, Lotti J, Tchernev G, Lotti T. An overview on radiotherapy: from its history to its current applications in dermatology. Open Access Maced J Med Sci 2017;5:521-525. 
  2. Rontgen WC. Eine neue Art von Strahlen. Vorlaufige Mitteilung. Vol. 30. Wurzburg: Sitzungsberichte der Physikalisch-medizinischen Gesellschaft zu Wurzburg; 1895. p. 132-141. 
  3. Grubbe EH. Priority in the therapeutic use of X-rays. Radiology 1933;21:156-162. 
  4. Becquerel H, Curie P. Action physiologiques des rayons du radium. C R Acad Sci Gen 1901;132:1289-1291. 
  5. Tward JD, Anker CJ, Gaffney DK, Bowen GM. Radiation therapy and skin cancer. Modern practices in radiation therapy. Rijeka: InTech; 2012. p. 207-246. 
  6. Chen HHW, Kuo MT. Improving radiotherapy in cancer treatment: promises and challenges. Oncotarget 2017;8:62742-62758. 
  7. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;69:7-34. 
  8. Miller KD, Nogueira L, Mariotto AB, et al. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin 2019;69:363-385. 
  9. Bryant AK, Banegas MP, Martinez ME, Mell LK, Murphy JD. Trends in radiation therapy among cancer survivors in the United States, 2000-2030. Cancer Epidemiol Biomarkers Prev 2017;26:963-970. 
  10. Baumann M, Krause M, Overgaard J, et al. Radiation oncology in the era of precision medicine. Nat Rev Cancer 2016;16:234-249. 
  11. Do NL, Nagle D, Poylin VY. Radiation proctitis: current strategies in management. Gastroenterol Res Pract 2011;2011:917941. 
  12. Terasawa T, Dvorak T, Ip S, Raman G, Lau J, Trikalinos TA. Systematic review: charged-particle radiation therapy for cancer. Ann Intern Med 2009;151:556-565. 
  13. Melian E, Mageras GS, Fuks Z, et al. Variation in prostate position quantitation and implications for three-dimensional conformal treatment planning. Int J Radiat Oncol Biol Phys 1997;38:73-81. 
  14. Fraass BA, Kessler ML, McShan DL, et al. Optimization and clinical use of multisegment intensity-modulated radiation therapy for high-dose conformal therapy. Semin Radiat Oncol 1999;9:60-77. 
  15. Shah SA, Cima RR, Benoit E, Breen EL, Bleday R. Rectal complications after prostate brachytherapy. Dis Colon Rectum 2004;47:1487-1492. 
  16. Lesperance RN, Kjorstadt RJ, Halligan JB, Steele SR. Colorectal complications of external beam radiation versus brachytherapy for prostate cancer. Am J Surg 2008;195:616-620; discussion 620. 
  17. Kennedy GD, Heise CP. Radiation colitis and proctitis. Clin Colon Rectal Surg 2007;20:64-72. 
  18. McKeown DG, Goldstein S. Radiation proctitis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020. 
  19. Denton A, Forbes A, Andreyev J, Maher EJ. Non surgical interventions for late radiation proctitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database Syst Rev 2002;CD003455. 
  20. Grodsky MB, Sidani SM. Radiation proctopathy. Clin Colon Rectal Surg 2015;28:103-111. 
  21. Tagkalidis PP, Tjandra JJ. Chronic radiation proctitis. ANZ J Surg 2001;71:230-237. 
  22. Gilinsky NH, Burns DG, Barbezat GO, Levin W, Myers HS, Marks IN. The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients. Q J Med 1983;52:40-53. 
  23. Lucarotti ME, Mountford RA, Bartolo DC. Surgical management of intestinal radiation injury. Dis Colon Rectum 1991;34:865-869. 
  24. Zeitlin SI, Sherman J, Raboy A, Lederman G, Albert P. High dose combination radiotherapy for the treatment of localized prostate cancer. J Urol 1998;160:91-95; discussion 95-96. 
  25. Buchi K. Radiation proctitis: therapy and prognosis. JAMA 1991;265:1180. 
  26. Wang CJ, Leung SW, Chen HC, et al. The correlation of acute toxicity and late rectal injury in radiotherapy for cervical carcinoma: evidence suggestive of consequential late effect (CQLE). Int J Radiat Oncol Biol Phys 1998;40:85-91. 
  27. Willett CG, Ooi CJ, Zietman AL, et al. Acute and late toxicity of patients with inflammatory bowel disease undergoing irradiation for abdominal and pelvic neoplasms. Int J Radiat Oncol Biol Phys 2000;46:995-998. 
  28. Hoffman R, Welton ML, Klencke B, Weinberg V, Krieg R. The significance of pretreatment CD4 count on the outcome and treatment tolerance of HIV-positive patients with anal cancer. Int J Radiat Oncol Biol Phys 1999;44:127-131. 
  29. Housri N, Yarchoan R, Kaushal A. Radiotherapy for patients with the human immunodeficiency virus: are special precautions necessary? Cancer 2010;116:273-283. 
  30. Newhauser WD, Berrington de Gonzalez A, Schulte R, Lee C. A review of radiotherapy-induced late effects research after advanced technology treatments. Front Oncol 2016;6:13. 
  31. Beard CJ, Propert KJ, Rieker PP, et al. Complications after treatment with external-beam irradiation in early-stage prostate cancer patients: a prospective multiinstitutional outcomes study. J Clin Oncol 1997;15:223-229. 
  32. Coia LR, Myerson RJ, Tepper JE. Late effects of radiation therapy on the gastrointestinal tract. Int J Radiat Oncol Biol Phys 1995;31:1213-1236. 
  33. Gerard J-P, Conroy T, Bonnetain F, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006;24:4620-4625. 
  34. Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006;355:1114-1123. 
  35. Yang TJ, Oh JH, Son CH, et al. Predictors of acute gastrointestinal toxicity during pelvic chemoradiotherapy in patients with rectal cancer. Gastrointest Cancer Res 2013;6:129-136. 
  36. Lin A, Abu-Isa E, Griffith KA, Ben-Josef E. Toxicity of radiotherapy in patients with collagen vascular disease. Cancer 2008;113:648-653. 
  37. Chon BH, Loeffler JS. The effect of nonmalignant systemic disease on tolerance to radiation therapy. Oncologist 2002;7:136-143. 
  38. Morris KA, Haboubi NY. Pelvic radiation therapy: between delight and disaster. World J Gastrointest Surg 2015;7:279-288. 
  39. Haboubi N. Pathology and pathogenesis of radiation bowel disease: histopathological appraisal in the clinical setting. EMJ Gastroenterol 2018;7:113-119. 
  40. Haboubi NY, El-Zammar O, O'Dwyer ST, James RJ. Radiation bowel disease: pathogenesis and management. Colorectal Dis 2000;2:322-329. 
  41. Metheetrairut C, Slack FJ. MicroRNAs in the ionizing radiation response and in radiotherapy. Curr Opin Genet Dev 2013;23:12-19. 
  42. Williams JM, Duckworth CA, Burkitt MD, Watson AJM, Campbell BJ, Pritchard DM. Epithelial cell shedding and barrier function: a matter of life and death at the small intestinal villus tip. Vet Pathol 2015;52:445-455. 
  43. Okunieff P, Cornelison T, Mester M, et al. Mechanism and modification of gastrointestinal soft tissue response to radiation: role of growth factors. Int J Radiat Oncol Biol Phys 2005;62:273-278. 
  44. Shadad AK, Sullivan FJ, Martin JD, Egan LJ. Gastrointestinal radiation injury: symptoms, risk factors and mechanisms. World J Gastroenterol 2013;19:185-198. 
  45. Rieder F, Brenmoehl J, Leeb S, Scholmerich J, Rogler G. Wound healing and fibrosis in intestinal disease. Gut 2007;56:130-139. 
  46. Villasanta U. Complications of radiotherapy for carcinoma of the uterine cervix. Am J Obstet Gynecol 1972;114:717-726. 
  47. Francois S, Bensidhoum M, Mouiseddine M, et al. Local irradiation not only induces homing of human mesenchymal stem cells at exposed sites but promotes their widespread engraftment to multiple organs: a study of their quantitative distribution after irradiation damage. Stem Cells 2006;24:1020-1029. 
  48. Francois S, Mouiseddine M, Mathieu N, et al. Human mesenchymal stem cells favour healing of the cutaneous radiation syndrome in a xenogenic transplant model. Ann Hematol 2007;86:1-8. 
  49. Paris F, Fuks Z, Kang A, et al. Endothelial apoptosis as the primary lesion initiating intestinal radiation damage in mice. Science 2001;293:293-297. 
  50. Bentzen SM. Preventing or reducing late side effects of radiation therapy: radiobiology meets molecular pathology. Nat Rev Cancer 2006;6:702-713. 
  51. Cotti G, Seid V, Araujo S, Souza AHS e, Kiss D rio R, Habr-Gama A. Conservative therapies for hemorrhagic radiation proctitis: a review. Rev Hosp Clin Fac Med Sao Paulo 2003;58:284-292. 
  52. Vanneste BGL, Van De Voorde L, de Ridder RJ, Van Limbergen EJ, Lambin P, van Lin EN. Chronic radiation proctitis: tricks to prevent and treat. Int J Colorectal Dis 2015;30:1293-1303. 
  53. Cox JD, Stetz J, Pajak TF. 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 1995;31:1341-1346. 
  54. Lund J-A, Kaasa S, Wibe A, Widmark A, Fransson P. Late radiation effects to the rectum and anus after treatment for prostate cancer; validity of the LENT/SOMA score. Acta Oncol 2013;52:727-735. 
  55. Cancer Therapy Evaluation Program. Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 [Internet]. Bethesda (MD): CTEP; c2017 [updated 2017 Nov 27; cited 2021 Apr 15]. Available from: https://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf. 
  56. Porouhan P, Farshchian N, Dayani M. Management of radiation-induced proctitis. J Family Med Prim Care 2019;8:2173-2178. 
  57. Katsanos KH, Sigounas DE, Christodoulou DK, Tsianos EV. Grading acute radiation bowel injury an unaddressed issue. Ann Gastroenterol 2012;25:65. 
  58. Zhong Q-H, Liu Z-Z, Yuan Z-X, et al. Efficacy and complications of argon plasma coagulation for hemorrhagic chronic radiation proctitis. World J Gastroenterol 2019;25:1618-1627. 
  59. Ali F, Hu KY. Evaluation and management of chronic radiation proctitis. Dis Colon Rectum 2020;63:285-287. 
  60. Tabaja L, Sidani SM. Management of radiation proctitis. Dig Dis Sci 2018;63:2180-2188. 
  61. Hanson B, MacDonald R, Shaukat A. Endoscopic and medical therapy for chronic radiation proctopathy: a systematic review. Dis Colon Rectum 2012;55:1081-1095. 
  62. Paquette IM, Vogel JD, Abbas MA, Feingold DL, Steele SR, Clinical practice guidelines Committee of The American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of chronic radiation proctitis. Dis Colon Rectum 2018;61:1135-1140. 
  63. Hille A, Herrmann MKA, Kertesz T, et al. Sodium butyrate enemas in the treatment of acute radiation-induced proctitis in patients with prostate cancer and the impact on late proctitis. A prospective evaluation. Strahlenther Onkol 2008;184:686-692. 
  64. Isenberg GA, Goldstein SD, Resnik AM. Formalin therapy for radiation proctitis. JAMA 1994;272:1822. 
  65. Dziki L, Kujawski R, Mik M, Berut M, Dziki A, Trzcinski R. Formalin therapy for hemorrhagic radiation proctitis. Pharmacol Rep 2015;67:896-900. 
  66. al-Sabbagh R, Sinicrope FA, Sellin JH, Shen Y, Roubein L. Evaluation of short-chain fatty acid enemas: treatment of radiation proctitis. Am J Gastroenterol 1996;91:1814-1816. 
  67. Swan MP, Moore GTC, Sievert W, Devonshire DA. Efficacy and safety of single-session argon plasma coagulation in the management of chronic radiation proctitis. Gastrointest Endosc 2010;72:150-154. 
  68. Ravizza D, Fiori G, Trovato C, Crosta C. Frequency and outcomes of rectal ulcers during argon plasma coagulation for chronic radiation-induced proctopathy. Gastrointest Endosc 2003;57:519-525. 
  69. Ben Soussan E, Mathieu N, Roque I, Antonietti M. Bowel explosion with colonic perforation during argon plasma coagulation for hemorrhagic radiation-induced proctitis. Gastrointest Endosc 2003;57:412-413. 
  70. Barbatzas C, Spencer GM, Thorpe SM, Sargeant LR, Bown SG, Carbatzas C. Nd:YAG laser treatment for bleeding from radiation proctitis. Endoscopy 1996;28:497-500. 
  71. Lee JK, Agrawal D, Thosani N, et al. ASGE guideline on the role of endoscopy for bleeding from chronic radiation proctopathy. Gastrointest Endosc 2019;90:171-182.e1. 
  72. Clarke RE, Tenorio LMC, Hussey JR, et al. Hyperbaric oxygen treatment of chronic refractory radiation proctitis: a randomized and controlled double-blind crossover trial with long-term follow-up. Int J Radiat Oncol Biol Phys 2008;72:134-143. 
  73. Dall'Era MA, Hampson NB, Hsi RA, Madsen B, Corman JM. Hyperbaric oxygen therapy for radiation induced proctopathy in men treated for prostate cancer. J Urol 2006;176:87-90. 
  74. Jao SW, Beart RW, Gunderson LL. Surgical treatment of radiation injuries of the colon and rectum. Am J Surg 1986;151:272-277. 
  75. McCrone LF, Neary PM, Larkin J, McCormick P, Mehigan B. The surgical management of radiation proctopathy. Int J Colorectal Dis 2017;32:1099-1108. 
  76. Anseline PF, Lavery IC, Fazio VW, Jagelman DG, Weakley FL. Radiation injury of the rectum: evaluation of surgical treatment. Ann Surg 1981;194:716-724. 
  77. Pricolo VE, Shellito PC. Surgery for radiation injury to the large intestine. Variables influencing outcome. Dis Colon Rectum 1994;37:675-684. 
  78. Yuan Z-X, Ma T-H, Wang H-M, et al. Colostomy is a simple and effective procedure for severe chronic radiation proctitis. World J Gastroenterol 2016;22:5598-5608. 
  79. Nichols TR. Quality of life in US residents with ostomies assessed via the SF36v2: role-physical, bodily pain, and general health domain. J Wound Ostomy Continence Nurs 2016;43:280-287. 
  80. Persson E, Berndtsson I, Carlsson E, Hallen A-M, Lindholm E. Stoma-related complications and stoma size - a 2-year follow up. Colorectal Dis 2010;12:971-976. 
  81. Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis 2010;12:958-964. 
  82. Arumugam PJ, Bevan L, Macdonald L, et al. A prospective audit of stomas--analysis of risk factors and complications and their management. Colorectal Dis 2003;5:49-52. 
  83. Shellito PC. Complications of abdominal stoma surgery. Dis Colon Rectum 1998;41:1562-1572. 
  84. Harris DA, Egbeare D, Jones S, Benjamin H, Woodward A, Foster ME. Complications and mortality following stoma formation. Ann R Coll Surg Engl 2005;87:427-431. 
  85. Suwanabol PA, Hardiman KM. Prevention and management of colostomy complications: retraction and stenosis. Dis Colon Rectum 2018;61:1344-1347. 
  86. Lev EL, Eller LS, Gejerman G, et al. Quality of life of men treated with brachytherapies for prostate cancer. Health Qual Life Outcomes 2004;2:28. 
  87. Liauw SL, Sylvester JE, Morris CG, Blasko JC, Grimm PD. Second malignancies after prostate brachytherapy: incidence of bladder and colorectal cancers in patients with 15 years of potential follow-up. Int J Radiat Oncol Biol Phys 2006;66:669-673.