THE VOLUME EFFECT IN RADIATION-RELATED LATE SMALL-BOWEL COMPLICATIONS- RESULTS OF A CLINICAL-STUDY OF THE EORTC-RADIOTHERAPY-COOPERATIVE-GROUP IN PATIENTS TREATED FOR RECTAL-CARCINOMA
Jgj. Letschert et al., THE VOLUME EFFECT IN RADIATION-RELATED LATE SMALL-BOWEL COMPLICATIONS- RESULTS OF A CLINICAL-STUDY OF THE EORTC-RADIOTHERAPY-COOPERATIVE-GROUP IN PATIENTS TREATED FOR RECTAL-CARCINOMA, Radiotherapy and oncology, 32(2), 1994, pp. 116-123
Citations number
22
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: The purpose of this study was to quantify the correlation bet
ween irradiated small bowel volume and late occurring small bowel comp
lications. Methods: Small bowel volumes in the high-dose region were m
easured using orthogonal barium films for 203 patients treated for rec
tal carcinoma with pelvic postoperative radiotherapy to 50 Gy in an EO
RTC multicentric study. Results: The 5-year estimate of late pelvic sm
all bowel obstruction requiring surgery was 11%. No correlation betwee
n the irradiated small bowel volume and obstruction was detected. The
actuarial 5-year estimate of chronic diarrhea varied from 31% in patie
nts with irradiated small bowel volumes below 77 cm(3) to 42% in patie
nts with volumes over 328 cm(3). This correlation was significant in t
he univariate and multivariate analysis (p = 0.025). The type of recta
l surgery significantly influenced the incidence of chronic diarrhea a
nd malabsorption, the actuarial 5-year estimate being 49% and 26% afte
r low anterior resection and abdominoperineal resection, respectively
(p = 0.04). Conclusions. This study demonstrated that there is a volum
e-effect in radiation-induced diarrhea at a dose of 50 Gy in 25 fracti
ons. No volume-effect for small bowel obstruction was detected at this
dose-level in pelvic postoperative radiotherapy. A review of the lite
rature data on small bowel obstruction indicates that the volume effec
t at this dose level can only be demonstrated in patients who were tre
ated with extended field radiotherapy (estimated small bowel volume 80
0 cm(3)) after intra-abdominal surgery.