Abstract
The article “Rectal dose assessment in patients submitted to high-dose-ratebrachytherapy for uterine cervix cancer” published in the present issue of RadiologiaBrasileira deals with a relevant theme currently discussed in radiotherapy and oncology.Radiation proctitis is condition of the rectum caused by ionizing radiation. It maybe acute (arising during or right after radiation therapy), and in these case is generallyself-limited. Symptoms of acute proctitis are diarrhea, eventual bleeding, mucus lossor constipation.Histological changes are limited to the mucosa, and the cells with a more rapidturnover are the most sensitive ones.Late radiation proctitis may occur up to two years after radiation therapy withmore severe symptoms: mucus loss, pain, rectal urgency, bleeding, ulceration, stenosisand even rectovaginal fistulas. In late radiation proctitis, histological findingscorrespond to changes of vascular nature and fibrosis of the subintimal layer.Radiation proctitis severity is directly proportional to the dose received and dosevolume, as well as to the number of fractions and the length of the interval betweenthem. It is this dose limitation (both in radiotherapy and chemotherapy) that producesbetter or worst results in the management of cancer.Radiation proctitis has been known for more than one century, but factorsdetermining a worsening in the prognosis such as association with other diseases(diabetes, hypertension, collagen diseases, etc.) have only recently been confirmed.Wherever possible, the treatment for radiation proctitis should be conservative.In the acute phase of the disease, symptomatic medication is generally enough to relievethe symptoms. The discomfort can be relieved with corticoid retention enema, besidesthe utilization of sulphasalazine. Major bleedings can be managed with argon lasertherapy. Although criticized by some authors, the utilization of hyperbaric oxygentherapy may also be useful. Colostomy should be the last resource to be adopted, inmost resistant cases
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