THE CORRELATION OF ACUTE TOXICITY AND LATE RECTAL INJURY IN RADIOTHERAPY FOR CERVICAL-CARCINOMA - EVIDENCE SUGGESTIVE OF CONSEQUENTIAL LATEEFFECT (CQLE)
Cj. Wang et al., THE CORRELATION OF ACUTE TOXICITY AND LATE RECTAL INJURY IN RADIOTHERAPY FOR CERVICAL-CARCINOMA - EVIDENCE SUGGESTIVE OF CONSEQUENTIAL LATEEFFECT (CQLE), International journal of radiation oncology, biology, physics, 40(1), 1998, pp. 85-91
Citations number
38
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: To correlate the acute toxicity during pelvic irradiation and
the development of late rectal injury following radiation therapy for
cervical carcinoma. Methods and Materials: Two hundred and twenty pat
ients treated with curative-intent radiation therapy between November
1987 and January 1992 were analyzed. Patients were treated initially w
ith external beam irradiation, 40-44 Gy/20-22 fractions to whole pelvi
s, followed by high dose rate intracavitary brachytherapy, 7.2 Gy to p
oint A for 3 fractions. Severity of diarrhea during radiation therapy
was scored according to six criteria: fecal characteristics, frequency
, onset, prescription of antidiarrheal agents, body weight loss during
irradiation, and extramedical care needed. Patients were categorized
as group ND (no obvious diarrhea), group MD (moderate diarrhea), and g
roup SD (severe diarrhea) for sum score 0-1, 2-5, and greater than or
equal to 6, respectively. The rate of radiation proctitis was expresse
d, analyzed, and compared with actuarial proctitis-free rate and preva
lence. Results: 1) According to the score, 76 (35%), 89 (40%), and 55
(25%) patients were categorized as group ND, group MD, and group SD, r
espectively. Distribution of patients and treatment characteristics am
ong the three groups appeared similar. Patients treated with a larger
field size, greater than or equal to 16.5 cm(2), tended to have increa
sed severity of diarrhea. 2) Overall, 103 patients (47%, 103 of 220) d
eveloped radiation proctitis. Twenty-one patients were in group ND (28
%, 21 of 76), 43 in group MD (48%, 43 of 89), and 39 in group SD (71%,
39 of 55). 3) The five-year actuarial proctitis-free rate was 72, 52,
and 29% for group ND, MD, and SD, respectively (p < 0.005). 4) Taking
time evolution and recoverability into account, the effect of diarrhe
a on the prevalence of radiation proctitis remained statistically sign
ificant at the first through the fourth year after irradiation. 5) Sev
erity of radiation proctitis and severity of diarrhea were not correla
ted (Spearman's rank correlation coefficient r(s) = 0.229, p = 0.098).
6) Cox's multivariate analysis revealed that severity of diarrhea was
the only factor that significantly correlated with the development of
radiation proctitis. Conclusion: Patients with increased acute toxici
ty and diarrhea during radiation therapy of cervical carcinoma signifi
cantly increased the risk of late rectal injury. This result suggested
that early excessive damage of acute-responding component of rectal w
all may play an important role in the initiation of late rectal injury
. Radiation proctitis can be accounted, in part, as a consequential la
te effect. (C) 1998 Elsevier Science Inc.