title: Rectal bleeding after radiation therapy for endometrial cancer.
abstract: OBJECTIVE
  The goals of this study were to determine the rate and risk factors of rectal bleeding (RB) after external beam radiotherapy and vaginal brachytherapy (EBRT +VB), and to compare these data to previously unreported RB rates from PORTEC-2 patients receiving EBRT or VB alone.
  
  
  METHODS
  Retrospective chart review identified 212 endometrial cancer patients receiving adjuvant EBRT+VB between 2006 and 2013. Patient-reported RB data were also obtained from PORTEC-2 patients randomized to EBRT (n=166) or VB (n=182). The two populations were compared using an RB scale of symptom severity.
  
  
  RESULTS
  After a median 35months, 17.9% of EBRT+VB patients (n=38) experienced any RB with 1.9% (n=4) having bleeding requiring intervention. Age ⩽70years was the only predictor of RB (OR 2.8; 95% CI 1.1-8.7; p=0.027). Rates of patient-reported RB after EBRT were similar with 15.0% (n=25) having any RB and 0.6% (n=1) having "very much" bleeding. On regression analysis, any EBRT (either EBRT alone or EBRT+VB) increased the risk of RB compared to those who received VB alone (OR 3.0; p=0.0028; 95% CI 1.4-6.7). The rates of more severe RB were low and did not significantly differ between treatments.
  
  
  CONCLUSIONS
  Significant RB is rare after radiation. EBRT has higher rates of rectal bleeding than VB. The addition of VB to EBRT does not significantly alter bleeding rates.
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, USA. Electronic address: dmitra1@partners.org.
authors.forename: Devarati
authors.initials: D
authors.lastname: Mitra
authors.affiliation: Department of Radiation Oncology, Leiden University Medical Center, The Netherlands.
authors.forename: Remi
authors.initials: R
authors.lastname: Nout
authors.affiliation: Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Department of Biostatistics, Harvard School of Public Health, Boston, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Catalano
authors.affiliation: Department of Radiation Oncology, Leiden University Medical Center, The Netherlands.
authors.forename: Carien
authors.initials: C
authors.lastname: Creutzberg
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Cimbak
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, USA.
authors.forename: Larissa
authors.initials: L
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, USA.
authors.forename: Akila N
authors.initials: AN
authors.lastname: Viswanathan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000009:adverse effects; D012007:Rectum / Q000293:injuries*; D012189:Retrospective Studies; D012307:Risk Factors; D014621:Vagina / Q000473:pathology
keywords: Endometrial cancer; Rectal bleeding; Vaginal brachytherapy