title: Rectal bleeding and its management after irradiation for uterine cervical cancer.
abstract: OBJECTIVE
  To present an evaluation of the risk factors of radiation-induced rectal bleeding and discuss its optimal management in patients with cancer of the cervix.
  
  
  METHODS
  A total of 213 patients treated with radiotherapy (RT) alone were included. All patients underwent external beam radiotherapy with high-dose-rate brachytherapy. The rectal dose was calculated by both the International Commission on Radiation Units and Measurements (ICRU) Report 38 guidelines and the anterior rectal wall point on radiographs. Rectal bleeding was scored using the late effects normal tissue-subjective, objective, management, and analytic criteria.
  
  
  RESULTS
  The incidence was 12.7% (27 of 213; Grade 1 in 9, Grade 2 in 16, and Grade 3 in 2). Most (92.6%) developed rectal bleeding within 2 years after RT completion (median 16 months). In univariate analysis, three significant factors were found: ICRU cumulative rectal biologically equivalent dose (CRBED) >100 Gy (19.7% vs. 4.2%), external beam RT dose to the parametrium >55 Gy (22.1% vs. 5.1%), and advanced stage (III-IV; 31.8% vs. 10.5%). In multivariate analysis, the ICRU-CRBED was the only significant factor. Six patients with Grade 1 bleeding experienced immediate relief with sucralfate enema for 1 month. For Grade 2 bleeding, sucralfate enema and/or coagulation were effective. Grade 3 bleeding lasted for 1 year despite frequent transfusions and coagulation.
  
  
  CONCLUSIONS
  Grade 2 and 3 rectal bleeding occurred in 8.5% of patients. The most significant risk factor was the ICRU-CRBED. Prompt treatment with a combination of sucralfate enema and coagulation was effective in controlling Grade 1 and 2 rectal bleeding without the development of fistula or stricture.
authors.affiliation: Department of Radiation Oncology, Ajou University Hospital, Suwon, South Korea. chunm@ajou.ac.kr
authors.forename: Mison
authors.initials: M
authors.lastname: Chun
authors.forename: Seunghee
authors.initials: S
authors.lastname: Kang
authors.forename: Hoon-Jong
authors.initials: HJ
authors.lastname: Kil
authors.forename: Young-Taek
authors.initials: YT
authors.lastname: Oh
authors.forename: Jeong-Hye
authors.initials: JH
authors.lastname: Sohn
authors.forename: Hee-Suk
authors.initials: HS
authors.lastname: Ryu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000150:complications / Q000628:therapy*; D011835:Radiation Protection / Q000379:methods; D012002:Rectal Diseases / Q000209:etiology / Q000628:therapy*; D012007:Rectum; D012307:Risk Factors; D013392:Sucralfate / Q000627:therapeutic use; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*
chemical_list: D000897:Anti-Ulcer Agents; D013392:Sucralfate