A Matched Case-Control Analysis of Clinical Outcomes for Patients With Inflammatory Bowel Disease and Rectal Cancer Treated With Pelvic Radiation Therapy

Mudgway, Ross; Bryant, Alex K.; Heide, Elena S.; Riviere, Paul; O'Hare, Connor; Rose, Brent S.; Murphy, James D.; Simpson, Daniel R.

doi:10.1016/j.ijrobp.2019.08.023

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…Three groups made up the sample: 71 patients with IBD who underwent RT, 71 matched controls without IBD, and 44 nonmatched controls with IBD treated without RT. 13 Patients with and without IBD had similar number of RT interruptions or use of antidiar-rheal medication. Also, the rate of complications in the long term was similar between the IBD patients who underwent RT and the nonmatched cohort of IBD patients treated without RT.…”

Section: Radiation Therapy In Ibd: Toxicity and Disease Activitymentioning

confidence: 94%

Rectal Cancer and Radiation in Colitis

Lynn

Cronin

Rangarajan

et al. 2023

Clin Colon Rectal Surg

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Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer. When IBD patients develop a rectal cancer, this should be treated with the same oncological principles and guidelines as the general population. Rectal cancer treatment includes surgery, chemotherapy, and radiation therapy (RT). Many IBD patients will require a total proctocolectomy with an ileal-pouch anal anastomosis (IPAA) and others, restoration of intestinal continuity may not be feasible or advisable. The literature is scarce regarding outcomes of IPAA after RT. In the present review, we will summarize the evidence regarding RT toxicity in IBD patients and review surgical strategies and outcomes of IPAA after RT.

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Section: Radiation Therapy In Ibd: Toxicity and Disease Activitymentioning

confidence: 94%

Rectal Cancer and Radiation in Colitis

Lynn

Cronin

Rangarajan

et al. 2023

Clin Colon Rectal Surg

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“…This measure of toxicity was assessed retrospectively in 66 patients in the Dutch pathology registry, and while significant, likely warrants further investigation in a larger population. While hospitalization rates for patients with IBD and rectal cancer during RT compares to those with sporadic rectal cancer, their need for RT breaks and anti-diarrhea medicines is not significantly higher ( 43 ), suggesting the concern and close monitoring of IBD patients may lower the threshold to recommend hospitalization. There is some suggestion that malignancies in the rectum are associated with higher rates of IBD flare in the peri-radiation period compared to other sites in the bowel ( 44 ).…”

Section: Ibd-associated Malignancies With Proximity To Bowelmentioning

confidence: 99%

“…Barnett et al found an increased risk of fecal urgency and loose stools in their IBD arm; although, the risk of proctitis, rectal bleeding, stool frequency, or urinary side effects was not increased compared to controls ( 142 ). Another study showed an increased risk of adhesions and small bowel obstruction in the IBD-RT arm; however, comparison to the IBD without RT arm suggests that these complications cannot be attributed to RT ( 43 ). In PCa, it is unclear whether D’Amico Risk Group or RT is associated with an increased risk for subsequent flare following treatment ( 4 , 10 , 143 ).…”

Section: Ibd During Radiation Therapymentioning

confidence: 99%

“…In PCa, it is unclear whether D’Amico Risk Group or RT is associated with an increased risk for subsequent flare following treatment ( 4 , 10 , 143 ). RT does not increase the risk of stricture, fistulation, or subsequent IBD activity/flare in the IBD population ( 9 , 15 , 43 ). Of note, 61% of patients with IBD treated with RT for various primary malignancies were classified as “in remission” from IBD 6 months after RT, with only 2 patients experiencing severe IBD symptoms during follow-up ( 9 , 44 ).…”

Section: Ibd During Radiation Therapymentioning

confidence: 99%

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Inflammatory bowel disease-associated malignancies and considerations for radiation impacting bowel: a scoping review

Bodofsky¹,

Freeman²,

Hong³

et al. 2022

J Gastrointest Oncol

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Background: Inflammatory bowel disease (IBD), subdivided into Crohn's disease (CD) and ulcerative colitis (UC), is an auto-inflammatory gastrointestinal condition with an established increased risk of certain malignancies. Compared to sporadic cancers in the general population, IBD-associated malignancies present unique challenges to providing quality care. Radiation therapy (RT) targeting IBD-associated malignancies may directly impact inflamed bowel, with special considerations for the risk of toxicities. Historically, patients with IBD have been less likely to receive radiotherapy in proximity to bowel due to a poor understanding of the potential for acute and chronic toxicities and unclear treatment outcomes. We present a scoping review, to more fully assess IBD-associated malignancies and their treatment. As opposed to a systematic review, this approach allows us to analyze the broadest range of literature, including experimental and non-experimental research, and reflect on current guidelines and practices.Methods: Literature search: a systematic, scoping search of published literature was conducted using applicable PRISMA scoping review (ScR) guidelines. The literature search was conducted on PubMed and was searched systematically by screening all publications from January 1990 to June 2021. Citations from the included articles were also manually searched. Relevant National Comprehensive Cancer Network guidelines were reviewed. Final query was December 2021 in editing. Articles were selected for full text reading if the abstract reported on malignancy in IBD or bowel toxicities. Results:The pelvic malignancies found in the IBD patient population, including colorectal carcinoma, anal carcinoma, lymphoma, small bowel adenocarcinoma (SBA), and prostate cancer (PCa) are outlined in this scoping review. Additional cancers that have a contested relationship with IBD, including cervical, bladder, and upper GI cancers, are also explored. This review provides literature guided recommendations on the eligibility of patients with IBD to receive RT, management of IBD during and after treatment, and counseling for radiation-induced toxicities.Conclusions: After review of the literature, IBD should not be considered an absolute contraindication to radiation therapy, given the lack of evidence for increased toxicities, and the evolution of RT techniques which limit radiation dose to the bowel.

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