title: Defecation into clothing without forewarning and mean radiation dose to bowel and anal-sphincter among gynecological cancer survivors.
abstract: BACKGROUND
  To analyze the relationship between mean radiation dose to the bowels and the anal-sphincter and occurrence of 'defecation into clothing without forewarning', a specific and serious fecal incontinence symptom after gynecological radiotherapy. Additional potential risk factors associated with the symptom are explored.
  
  
  METHODS
  Data were collected for 519 eligible gynecological cancer survivors, treated with pelvic radiotherapy, with a median follow-up of 5.8 years, using a study-specific questionnaire and medical records. Correlations between defecation into clothing without forewarning and mean dose to organs at risk; the anal-sphincter region, the rectum, the sigmoid and the small intestines were investigated, also taking other risk factors into account.
  
  
  RESULTS
  Twelve percent reported having had the symptom at least once in the preceding six months. Mean doses >50 Gy to the anal-sphincter region, the rectum, the sigmoid and the small intestines were related to the occurrence of the symptom. Significantly associated risk factors were deliveries with high birth weight, heart failure and lactose and/or gluten intolerance. After adjusting for these factors, mean doses >50 Gy to the anal-sphincter region, the sigmoid and the small intestines remained related to the occurrence of the symptom.
  
  
  CONCLUSIONS
  Mean doses to the bowels and anal-sphincter region are related to the risk of defecation into clothing without forewarning in long-term gynecological cancer survivors treated with pelvic radiotherapy. Further radiobiological modeling may distinguish which organ(s) contribute most to development of the symptom.
authors.affiliation: a Clinical Cancer Epidemiology, Department of Oncology and Pathology , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Helena
authors.initials: H
authors.lastname: Lind
authors.affiliation: a Clinical Cancer Epidemiology, Department of Oncology and Pathology , Karolinska Institutet , Stockholm , Sweden.|b Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden.
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Alevronta
authors.affiliation: a Clinical Cancer Epidemiology, Department of Oncology and Pathology , Karolinska Institutet , Stockholm , Sweden.|b Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
authors.affiliation: b Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden.|c Department of Oncology , Sahlgrenska University Hospital , Gothenburg , Sweden.
authors.forename: Ann-Charlotte
authors.initials: AC
authors.lastname: Waldenström
authors.affiliation: a Clinical Cancer Epidemiology, Department of Oncology and Pathology , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Tommy
authors.initials: T
authors.lastname: Nyberg
authors.affiliation: b Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden.|d Department of Radiation Physics , Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden.
authors.forename: Caroline
authors.initials: C
authors.lastname: Olsson
authors.affiliation: b Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden.
authors.forename: Ulrica
authors.initials: U
authors.lastname: Wilderäng
authors.affiliation: a Clinical Cancer Epidemiology, Department of Oncology and Pathology , Karolinska Institutet , Stockholm , Sweden.|g Department of Health Care Sciences , Ersta Sköndal University College , Stockholm , Sweden.
authors.forename: Gail
authors.initials: G
authors.lastname: Dunberger
authors.affiliation: a Clinical Cancer Epidemiology, Department of Oncology and Pathology , Karolinska Institutet , Stockholm , Sweden.|e Department of Medical Physics , Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Massoud
authors.initials: M
authors.lastname: Al-Abany
authors.affiliation: a Clinical Cancer Epidemiology, Department of Oncology and Pathology , Karolinska Institutet , Stockholm , Sweden.|f Department of Oncology and Department of Clinical and Experimental Medicine , Linköping University, Linköping , Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Åvall-Lundqvist
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000528:radiation effects; D001918:Brachytherapy / Q000009:adverse effects; D012809:Colon, Sigmoid / Q000187:drug effects; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications / Q000532:radiotherapy*; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D058958:Organs at Risk; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D012007:Rectum / Q000187:drug effects; D012307:Risk Factors; D011795:Surveys and Questionnaires; D017741:Survivors