title: Role of early proctoscopy in predicting late symptomatic proctitis after external radiation therapy for prostate carcinoma.
abstract: OBJECTIVE
  To determine whether acute radiation-proctitis, diagnosed by proctoscopy after radiation therapy for prostate cancer, can predict late clinical proctitis.
  
  
  METHODS
  A prospective study of 130 patients who underwent external radiation therapy (RT) for stage T1 to T4 prostate cancer between 1997 and 2008 was performed. Treatments were conventional (2-dimensional [2D]) in 61 patients and 3D conformal in 69, with a median target dose of 72 Gy (70-74 Gy). Within 1 week after RT, proctoscopy was performed to detect possible acute endoscopic proctitis (AEP). Acute clinical proctitis (ACP) and late clinical proctitis (LCP) were also evaluated. The median follow-up was 84 months (20-180 months). The influence of AEP and ACP on LCP occurrence was studied using the Cox model controlling for age, dose, prostatectomy, RT technique (2D vs 3D), and hormone therapy.
  
  
  RESULTS
  AEP was detected in 15 patients (11.5%) and ACP in 67 (51.5%); in 13 cases (10%) AEP and ACP occurred simultaneously. Thirty-five cases of LCP were recorded. The 5-year probability of developing LCP was highest in patients with AEP and ACP (77%, 95% confidence interval [CI] 53%-94%) and lowest in asymptomatic patients (14%, 95% CI 7%-26%; P<.001). Compared to asymptomatic patients, the 5-year probability also was slightly increased in patients with ACP only (26%, 95% CI 16%-40%; P=.052). In multivariable analysis, the combination of AEP and ACP was the main predictor of LCP: compared to asymptomatic patients, the hazard ratio was 5.6 (2.1-15.2) in patients with AEP plus ACP (P=.001) and 2.1 (0.9-4.9) in those with ACP only (P=.103).
  
  
  CONCLUSIONS
  In patients with AEP and ACP, the risk of LCP was more than 5-fold increased compared to those who were asymptomatic, while a much smaller increase in risk occurred in patients with ACP only. Early proctoscopy can provide valuable information regarding the likelihood of late proctitis.
authors.affiliation: Department of Radiation Oncology, Hospital Mater Salutis, Legnago, Italy. fcampostrini@aliceposta.it
authors.forename: Franco
authors.initials: F
authors.lastname: Campostrini
authors.forename: Renato
authors.initials: R
authors.lastname: Musola
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marchiaro
authors.forename: Federico
authors.initials: F
authors.lastname: Lonardi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Verlato
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D042241:Early Diagnosis; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011351:Proctoscopy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D018570:Risk Assessment; D013997:Time Factors