Mo2001 A Comparison of Rectal Evacuation Assessed by High Resolution Anal Manometry, Rectal Balloon Expulsion and Magnetic Resonance Proctography

Abstract

compared to treatment without ERB(3). However, except for our report that IGRT+ERB reduces GI symptoms at 1 month(4), there is no randomized trial data comparing the effects of IGRT ± ERB on anorectal symptoms and function. Here we present patient evaluation at 1 year from the same prospective, randomized study. Methods: 22 patients, (73(51-84) years) with localized CaP treated by IGRT ± ERB (with, n=11) underwent the following evaluation: (i) GI symptoms (modified LENT-SOMA questionnaires), (ii) anorectal motor and sensory function (manometry with sleeve sensor and rectal balloon) and (iii) anal sphincteric morphology (endoanal ultrasound), before IGRT, at 1 month, and 1 year after its completion. One way ANOVA examined changes in GI symptom, anorectal functional and anal sphincteric morphology within each group. Two way repeated measures ANOVA with post hoc, and χ2 tests examined the differences between groups. p≤0.05 considered significant. Results: In the IGRT alone group, increased bowel frequency [9(5-18) vs 19(1442) bowel actions/week, p<0.001] and fecal incontinence scores [0(0-0) vs 3(0-10), p<0.05] at 1 year compared to baseline were associated with a reduction in increased intra-abdominal pressure [98±17 vs 77±13mmHg, p<0.05]. In contrast, no changes in symptom, functional nor morphological parameters within the IGRT+ERB group were observed. LENT-SOMA rectal bleeding scores were worse for IGRT alone compared to IGRT+ERB [1(0-2) vs 0(01), p<0.01] at 1 year. The prevalence of frequency and urgency of defecation, fecal incontinence and rectal bleeding at 1 year was also increased in the IGRT alone group and had a worse impact on QOL compared with the IGRT+ERB group (Table). There were no differences in any of the anorectal functional nor anal sphincteric morphologic parameters between the treatment groups.Conclusion: Increased bowel frequency and fecal incontinence scores in the IGRT alone group at 1 year were associated with evidence of anorectal dysmotility. The increased prevalence of GI symptoms was greater and had a worse impact on QOL in the IGRT alone group compared with the IGRT+ERB group. Further follow-up is needed to determine if these differences are sustained. Yeoh et al. Int J Radiat Oncol Biol Phys 2012;84(5):e593-e599, Smeenk et al. Radiother Oncol 2010;95;277-282, van Lin et al. Int J Radiat Oncol Biol Phys 2007;67:799-811, Botten et al. Gastroenterology 2013; Vol 144(5):S1pS-366