Incidence Of Radiation Proctitis Research Articles

Radiation proctitis after iodine-125 low-dose-rate prostate brachytherapy utilizing SpaceOAR hydrogel.

We retrospectively evaluated the efficacy of combining the SpaceOAR (SOAR) hydrogel with prostate brachytherapy, using colonoscopy findings to assess for radiation proctitis. Among 731 patients undergoing iodine-125 low-dose-rate prostate brachytherapy (LDR-BT), SOAR was utilized in 394 patients (53.9%). Colonoscopy was performed for 97 patients (13.3%) to assess the presence, location, condition, and treatment of radiation proctitis. We also investigated treatment factors associated with the occurrence of radiation proctitis. Radiation proctitis was observed in 57 patients (7.8%) and 17 (2.3%) were treated with argon plasma coagulation (APC). The incidence of radiation proctitis was 12.2% in the non-SOAR and 4.1% in the SOAR group (p < 0.001). In the non-SOAR group, the incidence of radiation proctitis was 6.6% for LDR-BT monotherapy and increased to 22.0% when combined with external beam radiation therapy (EBRT) (p = 0.001). However, in the SOAR group, these rates significantly decreased to 3.3% and 5.7% for monotherapy and combination therapy, respectively (p = 0.035, p < 0.001). With SOAR, inflammation was observed directly above the DL in most patients (87.5%), and only one patient (6.3%) required APC. The absence of SOAR (p < 0.001, HR = 0.29) and the concurrent use of EBRT (p = 0.018, HR = 2.87) were identified as significant risk factors for the occurrence of radiation proctitis. The use of SOAR significantly reduced the incidence of radiation proctitis in patients undergoing LDR-BT monotherapy and combined EBRT. Inflammation primarily occurred directly above the DL; further examination is necessary to clarify its cause.

Incidence of radiation proctitis in cervical cancer receiving radiation therapy at Dr. Kariadi Hospital, Semarang, Indonesia

HIGHLIGHTS Radiotherapy is the primary treatment for advanced cervical cancer, offering hope and preserving quality of life for patients. Radiation proctitis is a concern post-radiotherapy, urging research to reduce its occurrence and improve the well-being of patients. ABSTRACT Objective: Knowing the incidence of radiation proctitis in cervical cancer patients after radiation at Dr. Kariadi Hospital, Semarang Materials and Methods: A descriptive study with analytical work on 356 cervical cancer patients who received radiation therapy at Dr. Kariadi Hospital Semarang from January 2017-December 2018 who met the inclusion criteria. Factors assessed included age, BMI, hematologic, stage, histopathology, history of radical hysterectomy surgery and duration of radiation. Cervical cancer staging was assessed using FIGO 2018. Statistical analysis was performed using Mann Whitney with a significant value if p &lt;0.05. Results: From the Chi-square analysis, the relationship between radiation period (less than 56 days and more than 56 days) (p=0.164), the relationship between age ≥45 and the incidence of proctitis (p=0.208), BMI ≥25 and the incidence of proctitis (p=0.838), Hb&lt; 10 with the incidence of proctitis (p=0.492), parity ≤1 with the incidence of proctitis (p=0.137) the relationship between the histopathological examination results with the incidence of proctitis (p=0.253), and stage level with the incidence of proctitis (p=0.226) were not significant. The highest incidence of proctitis occurred in stage 3B cervical cancer patients (14.5%). Conclusion: We found that the prevalence of proctitis in cervical cancer patients for the period 2017-2018 was 15.4%. Age, histopathological appearance, stage, history of anemia, history of radical surgery and appearance of symptoms after surgery with symptoms of proctitis did not show a significant relationship.

Construction of a predictive model for radiation proctitis after radiotherapy for female pelvic tumors based on machine learning.

Radiation therapy is a main method for female pelvic malignancies, which can cause some adverse reactions, such as radiation proctitis (RP). The incidence of RP is highly positively correlated with radiation dose. There is an urgent need for a scientific method to accurately predict the occurrence of RP to help doctors make clinical decisions. In this study, based on the clinical data of female pelvic tumor patients and dosimetric parameters of radiotherapy, the random forest method was used to screen the hub features related to the occurrence of RP, and then a machine learning algorithm was used to construct a risk prediction model for the occurrence of RP, in order to provide technical support and theoretical basis for the prediction and prevention of RP. A total of 100 female patients with pelvic tumors, who received static three-dimensional conformal intensity-modulated radiation therapy in the Department of Radiation Oncology of the Affiliated Hospital of Xiangnan University from January 2019 to December 2020, were retrospectively collected, and their clinically relevant data and radiotherapy planning system data were collected. During radiotherapy and 18 months after radiotherapy, 35 cases developed RP (RP group), and the remaining 65 cases had no RP (non-RP group). The clinical and dosimetric characteristics of patients were ranked by the importance of random forest algorithm, and the independent prognostic characteristics associated with the occurrence of RP were selected for machine learning modeling. A total of 6 machine learning algorithms including support vector machines, random forests, logistic regression, lightweight gradient boosting machines, Gaussian naïve Bayes, and adaptive enhancement were used to build models. The performance of the model was evaluated by the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F1 score. Finally, the random forest model was determined as the prediction model, and the calibration curve and decision curve of the prediction model were drawn to evaluate the accuracy and clinical benefit of the model. The parameters for random forest prediction model in the training set were as follow: AUC, 1.000, accuracy, 0.988, sensitivity, 1.000, specificity, 1.000, positive predictive value, 1.000, negative predictive value, 0.981, and F1 score, 1.000. In validation set, AUC was 0.713, accuracy was 0.640, sensitivity was 0.618, specificity was 0.822, positive predictive value was 0.500, negative predictive value was 0.656, and F1 score was 0.440. Random forest showed high predictive performance. Moreover, the Brief of the calibration curve for the prediction model was 0.178, the prediction accuracy was high, and the decision curve showed that the prediction model could benefit clinically. Based on the clinical and dosimetric parameters for the female pelvic tumor patients, the prediction model of radiation proctitis constructed by random forest algorithm has high predictive ability and strong clinical usability.

Progress in multidisciplinary treatment of hemorrhagic radiation proctitis

With the development and wide application of radiotherapy technology, the incidence of radiation proctitis (RP) caused by radiotherapy for pelvic malignant tumors tends to increase, especially the treatment of hemorrhagic RP (HRP) is very difficult. Complications such as intestinal necrosis and perforation cause great pain and inconvenience to patients. How to effectively and safely treat HRP is an urgent clinical problem to be solved. This article reviews the progress of multidisciplinary treatment of RP, especially HRP, in recent years, and focuses on the progress of formalin in the treatment of hemorrhagic radiation proctitis.

Prevention and treatment of radiation proctitis by retention enema

Objective To study the effect of prevention and treatment for patients with radiation proctitis by retention enema.Methods According to the digital table,120 patients with pelvic tumor treated with radiotherapy were randomly divided into two groups.The observation group was taken retention enema 2 to 14 days after radiotherapy once a day.The control group was taken retention enema when the patients with radiation proctitis after radiotherapy.The severity and frequency of radiation proctitis were observed in the two groups.Results The incidence of radiation proctitis in the observation group was 35.0％,which was significantly lower than that of the control group (83.3％) (χ2 =47.623,P =0.000).The severity of radiation proctitis was also significantly lower than that of control group.The incidence of Ⅱ and Ⅲ degree of radiation proctitis in the observation group were 3.3％,0,respectively,which were significantly lower than those of the control group (26.7％,6.7 ％) (χ2 =12.810、4.138,P =0.000、0.042).The total efficiency rate was 100.0％,which was significantly higher than that of the control group (72.0％)(χ2 =32.558,P =0.000).Conclusion Retention enema can effectively treat the radiation proctitis and the effect will be more significant if the retention enema starts soon after radiotherapy. Key words: Radiativity, proctitis ; Enema

Possible Risk Factors Associated with Radiation Proctitis or Radiation Cystitis in Patients with Cervical Carcinoma after Radiotherapy

Radiation proctitis and radiation cystitis are major complications for patients with cervical carcinoma following radiotherapy. In the present study, we aimed to determine the potential risk factors for the development of radiation proctitis and radiation cystitis after irradiation. A total of 1,518 patients with cervical carcinoma received external beam radiotherapy (EBRT) followed by high-dose-rate intracavitary brachytherapy (HDRICB) in our hospital. The incidences of radiation proctitis and radiation cystitis were recorded and associations with different factors (age, time period, tumor stage) were analyzed with χ2 (chi-squared) and Fisher exact tests. We found that 161 and 94 patients with cervical carcinoma were diagnosed with radiation proctitis and radiation cystitis, respectively, following radiotherapy. The prevalence of Grade I-II radiation proctitis or radiation cystitis was significantly lower than that of Grade III (radiation proctitis: 3.82% vs. 6.76%, P <0.05; radiation cystitis: 2.31% vs. 3.87%, P < 0.05) and was significantly enhanced in patients with late stage (IIIb) tumor progression compared to those in early stage (Ib, IIa) (P < 0.05). Moreover, the incidence of radiation proctitis and cystitis was not correlated with age or, time period following radiation, for each patient (P > 0.05). These observations indicate that a late stage of tumor progression is a potential risk factor for the incidence of radiation proctitis and cystitis in cervical carcinoma patients receiving radiotherapy.

High Complete Response Rate of Concomitant Chemoradiotherapy for Locally Advanced Squamous Cell Carcinoma of the Uterine Cervix

A prospective study with a newly designed schedule of concomitant chemoradiotherapy was initiated for 42 patients with previously untreated squamous cell carcinoma of the uterine cervix. Their ages ranged from 34 to 77 years, median 57 years. There were 13 FIGO stage IIB, 1 IIIA, 27 IIIB, and 1 IVA. Radiotherapy was administered using 1.8 Gy/day, 5 days a week, to the whole pelvis (50.4 Gy/28 fractions) with local boost if indicated. Intracavitary brachytherapy of 5 Gy for five times was delivered after 1–2 weeks of rest. The first 21 patients received concomitant chemotherapy of biweekly PEB regimen (100 mg/m2etoposide + 50 mg/m2cisplatin + 50 mg/m2bleomycin) for two to three cycles during external irradiation. The chemotherapy for the latter 21 patients was modified to weekly PEBF (50 mg/m2etoposide + 20 mg/m2cisplatin + 10 mg/m2bleomycin + 800 mg/m25-FU, mixed in normal saline, 24-hr continuous iv infusion) for five to six cycles. All except 1 patient achieved complete response (97.6%) and sustain so after a median follow-up time of 30 months. There were three relapses—one with persistent pelvic disease and two with distant metastasis. Two-year overall survival and disease-free survival rates were 97.6 and 92.9%, respectively. Myelosuppression was moderate but fully recovered. Other acute toxicities were tolerated except for 1 patient who encountered grade IV radiation colitis with cecum perforation and required surgery. As to late morbidity, the incidence of radiation proctitis was high (21.4%) but of a mild degree, with 1 patient needing repeated transfusion. One patient developed chronic cystitis with an acontractile bladder. Our preliminary results show that concomitant chemoradiotherapy for advanced cervical carcinoma is both feasible and effective with acceptable toxicities. Further follow-up is mandatory to ensure whether this high complete response protocol will translate into long-term local control and survival.