Chemotherapy for leukaemia following previous pelvic radiotherapy is associated with severe enteritis and haemorrhagic cystitis

We describe two patients who developed extensive ulceration, haemorrhage an d necrosis of bladder or bowel following treatment with intensive chemother apy for acute leukaemia. Major surgical intervention was required in both c ases. Both patients had previously undergone pelvic radiotherapy for gynaec ologic malignancy and had suffered symptoms of chronic radiation-induced cy stitis and enteritis. Bowel and bladder histology showed evidence of chroni c radiation cystitis or enteritis. We postulate that combined mucosal toxic ity secondary to cytotoxic therapy and chronic radiation-induced damage to bowel or bladder mucosa resulted in critical ischaemia, ulceration and necr osis of bowel and bladder. Caution must be exercised in the treatment of pa tients receiving intensive chemotherapy if there is a history of chronic ra diation enteritis or cystitis, and dosage reductions may be justified.