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[en] Due to modern irradiation treatment methods, skin injuries are uncommon as opposed to bowel lesions, which seem to increase. Follow up investigations were carried out in 130 patients, 68 suffered from an acute type of irradiation proctitis, and 62 had symptoms characteristic of the chronic type. In every instance rectosigmoidoscopy was completed with histological examination too. The acute damage was easy to manage, but the treatment of symptoms and signs in chronic patients was a difficult problem. Even surgical intervention was needed in 4 instances. A prospective investigation was carried out in 25 patients. Rectosigmoidoscopy took place before, during and after irradiation therapy. Gastrointestinal complaints occurred only in 12 Both endoscopically and histologically the evidence of an acute inflammation was considered in 80% of all irradiated patients. During a 2 years follow up the chronic type of damage occurred in 2 cases. According to our experience, the chronic type of irradiation proctitis could be expected in 1 of 10 patients. Methods to prevent the development of chronic radioproctitis before radiotherapy and the detection and elimination of predisposing lesions during radiotherapy by endoscopic and histological monitoring seem to be useful
[en] Although patients experience radiation proctitis post radiotherapy no internationally tested instruments exist to measure these symptoms. This Phase IV study tested the scale structure, reliability and validity and cross-cultural applicability of the EORTC proctitis module (QLQ-PRT23) in patients who were receiving pelvic radiotherapy. Patients (n = 358) from six countries completed the EORTC QLQ-C30, QLQ-PRT23 and EORTC Quality of Life Group debriefing questions. Clinicians completed the EORTC Radiation Therapy Oncology Group scale. Questionnaires were completed at four time-points. The module’s scale structure was examined and validated using standard psychometric analysis techniques. Three items were dropped from the module (QLQ-PRT23 → QLQ-PRT20). Factor analysis identified five factors in the module: bowel control; bloating and gas; emotional function/lifestyle; pain; and leakage. Inter-item correlations were within r = 0.3–0.7. Test-Retest reliability was high. All multi-item scales discriminated between patients showing symptoms and those without symptomology. The module discriminated symptoms from the clinician completed scoring and for age, gender and comorbidities. The EORTC QLQ-PRT20 is designed to be used in addition to the EORTC QLQ-C30 to measure quality of life in patients who receive pelvic radiotherapy. The EORTC QLQ-PRT20 is quick to complete, acceptable to patients, has good content validity and high reliability. Australian and New Zealand Clinical Trials Registry (ANZCTR) http://anzctr.org.au/ . The online version of this article (10.1186/s13014-018-1107-x) contains supplementary material, which is available to authorized users.
[en] Acute proctitis, clinically expressed as tenesmus and/or increased stool frequency with formed faecies, is often a complication of pelvic irradiation. Clinical and histological damage by non specific acute proctitis has been efficiently reduced by 5-aminosalicylic acid (5-ASA). A two-arm radomized trial was carried out to determine the correlation between symptoms and histologically damage in acute actinic proctitis in the control group and its possible prevention with 5-ASA in the treated group
[en] Purpose: To determine whether participants taking angiotensin-converting enzyme inhibitors (ACEIs) and treated with radical radiation therapy with neoadjuvant/adjuvant hormone therapy have less incidence, severity, and duration of radiation proctitis. Methods and Materials: A propensity score analysis of 817 patients who underwent radical radiation therapy with neoadjuvant or adjuvant hormone therapy as primary line management in a cohort study during 2009 to 2013 was conducted. Patients were stratified as follows: group 1, hypertensive patients taking ACEIs (as a study group); group 2, nonhypertensive patients not taking ACEIs; and group 3, hypertensive patients not taking ACEIs (both as control groups). The incidence, severity, and duration of proctitis were the main outcome. χ"2 tests, Mann-Whitney U tests, analysis of variance, risk ratio (RR), confidence interval (CI), Kaplan-Meier plots, and log-rank tests were used. Results: The mean age of the participants was 68.91 years, with a follow-up time of 3.38 years. Based on disease and age-matched comparison, there was a statistically significant difference of proctitis grading between the 3 groups: χ"2 (8, n=308) = 72.52, P<.001. The Mann-Whitney U test indicated that grades of proctitis were significantly lower in hypertensive patients taking ACEIs than in nonhypertensive patients not taking ACEIs and hypertensive patients not taking ACEIs (P<.001). The risk ratio (RR) of proctitis in hypertensive patients taking ACEIs was significantly lower than in hypertensive patients not taking ACEIs (RR 0.40, 95% CI 0.30-0.53, P<.001) and in nonhypertensive patients not taking ACEIs (RR 0.58, 95% CI 0.44-0.77, P<.001). Time to event analysis revealed that hypertensive patients taking ACEIs were significantly different from the control groups (P<.0001). Furthermore, hypertensive patients taking ACEIs had significantly faster resolution of proctitis (P<.0001). Conclusion: Patients who were taking ACEIs were significantly less likely to have high-grade proctitis after radical radiation therapy with neoadjuvant or adjuvant hormone therapy (P<.001). The intake of ACEIs was significantly associated with a reduced risk of radiation-induced proctitis and also with acceleration of its resolution.
[en] Purpose: Our objective was to assess, retrospectively, the efficacy of hyperbaric oxygen treatment in radiation proctitis in all patients who have completed treatment for this disease at the Fremantle Hyperbaric Oxygen Unit. This unit is the only one of its kind in Western Australia. Methods and Materials: Patients were assessed by a review of hospital records, blood bank records, and clinic review (if this was convenient), and all patients responded to a telephone survey. Patients were questioned regarding radiation proctitis symptoms and the degree to which each had improved. Results: Most patients had previously been treated with radiotherapy for prostate carcinoma. Patients with proctitis mainly suffered from bleeding, diarrhoea, incontinence, and pain. In more than half of these patients, symptoms partially or completely resolved after hyperbaric oxygen treatment. Conclusion: Radiation-induced proctitis is a difficult clinical problem to treat and will probably become more significant with the rising incidence of diagnosis of prostate cancer. Hyperbaric Oxygen should be considered in the treatment of radiation-induced proctitis. Further prospective trials with strict protocol guidelines are warranted
[en] Radiogenic proctitis is a frequent complication of therapeutic radiation at the pelvic region. The aim of this study was to determine the efficacy of the epidermal growth factor (EGF) in treating patients with proctitis as a complication of radiotherapy of gynecological tumors. A phase II, placebo-controlled, randomized, double blind clinical trial was carried out. The treatment groups were: A) a solution of human recombinant epidermal growth factor (10 μg/ml) in carboxymethyl cellulose or B) placebo (carboxymethylcellulose solution alone); the treatment was administered as a retention enema (20 mL) twice a day after bowel movement for 6 months. We included women of 18-75 years of age with proctitis as a complication of an ionizing radiation treatment of gynecological malignant tumors, confirmed by endoscopy, who gave their consent to participate. Thirty-seven patients were included. The basic demographic variables and were homogeneous among groups, which were comparable. There were more responses in group A (EGF) than in the control (placebo), but the difference was not statistically significant. Considering only those patients who completed the treatment, the difference in response was greater with EGF (86% vs60%). The symptoms disappeared more rapidly in the group treated with EGF (p=0.027 and p=0.016, for bleeding and tenesmus, respectively). The product under study was well tolerated. Although there are signs of improvement in some symptoms, the sample was too small to demonstrate the effectiveness of Hebervis in the treatment of proctitis. (Author)
[en] Purpose: To investigate the significance of the various late rectal symptoms that appear after radical prostatic irradiation.Patients and methods: Patients with localised prostate cancer treated between 1987 and 1994 at the Mater Hospital, Newcastle with radical megavoltage irradiation were recalled for examination and to complete a detailed questionnaire concerning late radiation-induced symptoms and their effects on normal daily life. The influence of patient age treatment related variables and acute proctitis symptoms occurring during therapy or the late symptoms recorded were assessed and the relationship between late symptoms and late EORTC/RTOG score and impact on normal daily life were studied.Results: The presence of symptoms of acute proctitis was the only factor to predict any of three late symptoms (urgency, frequency and diarrhoea) and late EORTC/RTOG score in this series (odds ratios: 1.7-2.57, P-values: 0.009-0.0007). Cluster and discriminant function analyses revealed the presence of five subgroups of patients with varying permutations of different late rectal symptoms, including one group with minimal symptoms (P<0.0001). While bleeding and rectal discharge were the major contributors to late EORTC/RTOG score (P<0.0001 and 0.04), faecal urgency and bleeding were the most important factors to impact on normal daily life (P<0.0001 and P<0.0003). A relatively low concordance was found between late EORTC/RTOG score and the patients' self assessment on the effect of their symptoms on their normal daily lives. Some late symptoms, including bleeding and rectal discharge become less prevalent after 3 years of follow-up with a resulting improvement in EORTC/RTOG score.Conclusions: There may be more than one late (chronic) proctitis syndrome which may be linked in greater or lesser degrees to acute proctitis symptoms occurring during therapy. Urgency is a common late symptom which often has an important impact on normal daily life and deserves recognition in late normal tissue scoring systems. Assessment of the incidence of bleeding as a measure of late rectal morbidity following prostate irradiation may underestimate the impact of these chronic effects. Confirmatory studies are necessary. (Copyright (c) 1999 Elsevier Science B.V., Amsterdam. All rights reserved.)
[en] Background and purpose: The Normal Tissue Complication Probability (NTCP) for rectum is usually defined for late rectal bleeding. This study calculates NTCP parameter values for additional rectal toxicity endpoints observed in clinical practise. Materials and methods: 388 patients from the multicentre MRC-RT01 prostate conformal radiotherapy trial (ISRCTN 47772397) were used to derive independent Lyman Kutcher Burman model (LKB) parameters for five late rectal toxicity endpoints: rectal bleeding, proctitis, stool frequency, loose stools and rectal urgency. The parameters were derived using maximum likelihood estimation. Bootstrap and leave-one-out methods were employed to test the generalisability of the results for use in a general population. Results: A consistent pattern of increasing value of TD50(1) for Grade 2 toxicity only compared to Grades 1 and 2 toxicity was observed for all endpoints. Parameter values varied between endpoints (particularly for the volume parameter n). TD50(1), m and n were 68.5 Gy (95% CI)(66.8–70.8), 0.15 (0.13–0.17) and 0.13 (0.10–0.17), respectively, for G2 rectal bleeding. Bootstrap and leave-one-out results showed that the rectal bleeding and proctitis parameter fits were extremely robust. Conclusions: The variation between the values derived for different endpoints may indicate different patho-physiological responses of the rectum to radiation. Therefore different parameter sets would be required to predict specific rectal toxicity endpoints.
[en] Background. The high anal abscess might have not a typical, chronic clinical course, and its diagnosis may be difficult. Case report. The authors describe a case of a patient with the initial diagnosis of rectal cancer. Because of non-specific clinical symptoms suggesting a high anal abscess with atypical, chronic course of the disease, additional investigations were suggested. The final diagnosis was high, submucous-intersphincteric abscess. Conclusions. In the described case the most important ones turned out to be an exact finger per rectum examination, clinical proctologic assessment, and the transrectal ultrasound. (author)