Anorectal injury following pelvic radiotherapy

Background: Current knowledge of the effects of radiation on the anorectum is based on a limited number of studies. Variability in delivery techniques , both currently and historically, combined with a paucity of prospective a nd randomized studies makes interpretation of the literature difficult. Thi s review presents the existing evidence and identifies areas that require f urther work. Methods: This review is based on a literature search (Medline and PubMed) a nd manual cross-referencing. Results and conclusion: More than three-quarters of patients receiving pelv ic radiotherapy experience acute anorectal symptoms and up to one-fifth suf fer from late-phase radiation proctitis. About 5 per cent develop other chr onic complications, such as fistula, stricture and disabling faecal inconti nence. The risk of rectal cancer may be increased. Conservative treatment o ptions are of limited value. Surgery may be considered if symptoms are seve re, provided sphincter function is adequate and recurrent disease is exclud ed. Large prospective studies with accurate dosimetric data and long-term f ollow-up are needed to provide meaningful information on which to base new strategies to minimize the side-effects from radiotherapy.