Rectal bleeding and its management after irradiation for uterine cervical cancer.
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.
Chun
Mison
M
Department of Radiation Oncology, Ajou University Hospital, Suwon, South Korea. chunm@ajou.ac.kr
Kang
Seunghee
S
Kil
Hoon-Jong
HJ
Oh
Young-Taek
YT
Sohn
Jeong-Hye
JH
Ryu
Hee-Suk
HS
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*
D000897:Anti-Ulcer Agents; D013392:Sucralfate