Is there more than one late radiation proctitis syndrome?

Purpose: To investigate the significance of the various late rectal symptom s that appear after radical prostatic irradiation. Patients and methods: Patients with localised prostate cancer treated betwe en 1987 and 1994 at the Mater Hospital, Newcastle with radical megavoltage irradiation were recalled for examination and to complete a detailed questi onnaire concerning late radiation-induced symptoms and their effects on nor mal daily life. The influence of patient age treatment related variables an d acute proctitis symptoms occurring during therapy or the late symptoms re corded were assessed and the relationship between late symptoms and late EO RTC/RTOG score and impact on normal daily life were studied. Results: The presence of symptoms of acute proctitis was the only factor to predict any of three late symptoms (urgency, frequency and diarrhoea) and late EORTC/RTOG score in this series (odds ratios: 1.7-2.57, P-values: 0.00 9-0.0007). Cluster and discriminant function analyses revealed the presence of five subgroups of patients with varying permutations of different late rectal symptoms, including one group with minimal symptoms (P < 0.0001). Wh ile bleeding and rectal discharge were the major contributors to late EORTC /RTOG score (P < 0.0001 and 0.04), faecal urgency and bleeding were the mos t important factors to impact on normal daily life (P < 0.0001 and P < 0.00 03). A relatively low concordance was found between late EORTC/RTOG score a nd the patients' self assessment on the effect of their symptoms on their n ormal daily lives. Some late symptoms, including bleeding and rectal discha rge become less prevalent after 3 years of follow-up with a resulting impro vement in EORTC/RTOG score. Conclusions: There may be more than one late (chronic) proctitis syndrome w hich may be linked in greater or lesser degrees to acute proctitis symptoms occurring during therapy. Urgency is a common late symptom which often has an important impact on normal daily life and deserves recognition in late normal tissue scoring systems. Assessment of the incidence of bleeding as a measure of late rectal morbidity following prostate irradiation may undere stimate the impact of these chronic effects. Confirmatory studies are neces sary. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.