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Pathogenesis of acute radiation injury to the rectum

A prospective study in patients

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Abstract

In a prospective investigation of the clinical and pathological effects of pelvic radiotherapy on the rectum, nine patients (age range 58–77 years) had symptoms assessed weekly during radical treatment for bladder and prostatic tumours, and at 2, 4 and 12 weeks after treatment. Stool frequency increased in all patients from a mean of 1.7 per day before treatment to 5.0 per day at 4 weeks (P<0.05). Seven patients developed liquid stools during treatment; 6 had pain on defaecation, 8 had urgency of defaecation, all experienced tenesmus and 3 had episodes of faecal incontinence. One patient had symptoms of such severity that treatment was interrupted. Virtually all symptoms had resolved by 12 weeks after treatment. Sigmoidoscopy with biopsy of anterior and posterior rectal walls was performed before treatment began, at 2 weeks and 4 weeks during treatment, and 4 and 12 weeks after treatment. All patients during treatment had evidence of acute inflammatory damage with hyperaemic, oedematous mucosa and failure of healing of biopsy sites. Histological examination of the rectal biopsies revealed the well described characteristic mucosal changes with crypt cell damage, inflammatory cell infiltrate and loss of crypts. In 2 of 7 cases studied, pathology was still abnormal at 3 months. Radiation injury to bowel is an underemphasised cause of morbidity and further prospective studies are required to determine methods of reducing normal tissue damage and ameliorating symptoms.

Résumé

Les répercussions cliniques et pathologiques sur le rectum d'une radiothérapie pelvienne ont été étudiées prospectivement; les symptômes présentés par 9 patients (âgés de 58–77 ans) ont été analysés de manière hebdomadaire au cours d'un traitement radical d'une tumeur de la vessie ou de la prostate puis 2, 4 et 12 semaines après la fin du traitement. La fréquence des exonérations augmente chez tous les patients de 1,7x/jour en moyenne avant traitement à 5,0x/jour à 4 semaines (P<0,05). Sept patients ont développé des diarrhées en cours de traitement; 6 ont eu des douleurs au cours de la défécation, 8 ont des défécations impérieuses, tous ont eu des ténesmes et 3 des épisodes d'incontinence. Chez un patient, les symptômes étaient si sévères que le traitement a dû être interrompu. Virtuellement, tous les symptômes disparaissent 12 semaines après la fin du traitement. Au cours de sigmoïdoscopies pratiquées avant le traitement, à la 2ème et 4ème semaine du traitement et 4 à 12 semaines après le traitement des biopsies ont été prélevées sur la paroi antérieure et la paroi postérieure du rectum. Tous les patients présentent au cours du traitement des altérations inflammatoires aïguës avec hyperémie, oedème muqueux, non guérison des sites de biopsie. L'examen histologique des biopsies montre les atteintes bien connues de la muqueuse avec altération des cellules glandulaires, infiltration cellulaire inflammatoire et destruction des cryptes. Dans 2 des 7 cas, les anomalies sont toujours présentes à 3 mois. Les répercussions sur la morbidité des lésions radiques de l'intestin sont sous-estimées et exigent d'autres études prospectives afin de déterminer les moyens de réduire les atteintes des tissus normaux et d'améliorer la symptomatologie.

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Authors and Affiliations

  1. Department of Medicine, University of Edinburgh, Crewe Road, Edinburgh, UK

    D. M. Sedgwick & A. Ferguson

  2. Western General Hospital, Crewe Road, Edinburgh, UK

    D. M. Sedgwick, G. C. W. Howard & A. Ferguson

  3. Department of Radiation Oncology, University of Edinburgh, Crewe Road, Edinburgh, UK

    G. C. W. Howard

Authors
  1. D. M. Sedgwick
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  2. G. C. W. Howard
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  3. A. Ferguson
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Sedgwick, D.M., Howard, G.C.W. & Ferguson, A. Pathogenesis of acute radiation injury to the rectum. Int J Colorect Dis 9, 23–30 (1994). https://doi.org/10.1007/BF00304295

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