Gastrointestinal tract complications following radiotherapy of uterine cervical cancer: past and present

A retrospective analysis of the gastrointestinal tract complications in 298 patients with cervical cancer treated with radiotherapy at the State University of New York at Buffalo and Albert Einstein College of Medicine affiliated hospitals was carried out. Fifty-two patients had pretreatment surgical staging (39 transperitoneal and 13 extraperitoneal). Twenty-four percent had varying degrees of radiation sickness. They all responded to conservative therapy. Seven percent developed Stage I radiation proctitis. In the clinical staging group late complications consisted of: Three small bowel injuries, 4% persistent Stage I, 3% Stage III, and one patient with Stage II radiation proctitis. Among 39 patients who had transperitoneal surgical staging, two small bowel injuries, one case of gastric ulcer, and three cases of radiation proctitis were encountered. Only one of 13 patients who had extraperitoneal surgical staging developed intestino-vesico-vaginal fistula. A literature search was conducted, and prophylactic and therapeutic measures are discussed. The importance of careful selection of patients for radiotherapy and recognition of high risk clinical factors is reemphasized