Radiation enterocolitis requiring surgery in patients with gynecological malignancies.
OBJECTIVE
To identify the characteristics, risk factors, and clinical outcomes of radiation enterocolitis requiring surgery in patients with gynecologic malignancies.


METHODS
The records of 1,349 patients treated with pelvic radiotherapy were retrospectively reviewed. The majority of the patients (88%) were treated with 50 Gy or 50.4 Gy pelvic irradiation in conventional fractionations with anteroposterior fields.


RESULTS
Forty-eight patients (3.6%) developed radiation enterocolitis requiring surgery. Terminal ileum was the most frequent site (50%) and most of the lesions had stenosis or perforation. On univariate analysis, previous abdominopelvic surgery, diabetes mellitus (DM), smoking and primary site had an impact on the complications, and on multivariate analysis, abdominopelvic surgery, DM, and smoking were independent predictors of the complications requiring surgery. After the surgical intervention, the frequency of Grade 2 or more bleeding was significantly lower in patients treated with intestinal resection in addition to decompression than those treated with intestinal decompression alone.


CONCLUSIONS
Severe radiation enterocolitis requiring surgery usually occurred at the terminal ileum and was strongly correlated with previous abdominopelvic surgery, DM, and smoking. Concerning the management, liberal resection of the affected bowel appears to be the preferable therapy.
Iraha
Shiro
S
Department of Radiology, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa 903-0215, Japan.
Ogawa
Kazuhiko
K
Moromizato
Hidehiko
H
Shiraishi
Masayuki
M
Nagai
Yutaka
Y
Samura
Hironori
H
Toita
Takafumi
T
Kakinohana
Yasumasa
Y
Adachi
Genki
G
Tamaki
Wakana
W
Hirakawa
Makoto
M
Kamiyama
Kazuya
K
Inamine
Morihiko
M
Nishimaki
Tadashi
T
Aoki
Yoichi
Y
Murayama
Sadayuki
S
D000704:Analysis of Variance; D004760:Enterocolitis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy*; D006801:Humans; D007422:Intestines / Q000528:radiation effects*; D008875:Middle Aged; D011832:Radiation Injuries / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors