Spontaneous improvement in late rectal mucosal changes after radiotherapy for prostate cancer.
OBJECTIVE
To describe the natural history of mucosal changes, in particular the development of telangiectases in the rectum, after radiotherapy (RT) for prostate cancer.


METHODS
Twenty patients undergoing local-field, nonconformal RT for prostate cancer underwent flexible sigmoidoscopy every 6 months for up to 3 years after RT completion. Telangiectasis was scored as absent, single, multiple, or multiple confluent. The site and circumferential extent were also documented. The patients filled in a diary to document the symptoms they were experiencing, including rectal bleeding.


RESULTS
Of the 20 patients, 12 developed multiple telangiectases, and 10 of these had rectal bleeding, which in all cases was mild. Telangiectasis was most commonly seen between 4 (anorectal junction) and 8 cm from the anal verge. In 5 patients, 4 of whom had multiple telangiectases, spontaneous resolution occurred.


CONCLUSIONS
Late radiation effects in the rectum do not appear to be permanent in all cases. This first prospective prolonged evaluation may provide an explanation for the observation that rectal bleeding resolves in a large proportion of patients with mild symptoms after RT. The reasons for improvement in the late radiation changes in the rectum compared with the permanent changes seen in organs such as the skin are unknown.
O'Brien
Peter C
PC
Department of Radiation Oncology, Newcastle Mater Hospital, Waratah, NSW, Australia. Peter.OBrien@mater.health.nsw.gov.au
Hamilton
Christopher S
CS
Denham
James W
JW
Gourlay
Ralph
R
Franklin
C Ian V
CI
D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007413:Intestinal Mucosa / Q000528:radiation effects; D008297:Male; D011349:Proctitis / Q000209:etiology / Q000473:pathology; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000150:complications*; D011879:Radiotherapy Dosage; D012002:Rectal Diseases / Q000209:etiology* / Q000473:pathology; D012007:Rectum / Q000098:blood supply / Q000528:radiation effects*; D012812:Sigmoidoscopy; D013684:Telangiectasis / Q000209:etiology* / Q000473:pathology