Pelvic Radiation Disease

Abstract

Pelvic radiation is increasingly being used for the neoadjuvant and definitive treatment of pelvic organ malignancy. While this treatment can be highly effective, and may assist in organ sparing, it is also associated with significant toxicity and devastating adverse events that need to be considered. In broad terms, pelvic radiation disease affects both the primary target organ as well as adjacent organs and soft tissue structures, with complications that can be classified and graded according to consensus criteria. The complication grade is often modality, dose, and area dependent. The most common manifestations are proctitis, cystitis, recto-urethral fistula, ureteric stricture, and bone involvement. Toxicity can be misdiagnosed for many years, resulting in significant management delays. Complications can be difficult to prevent and challenging to treat, requiring specialized multi-disciplinary input to achieve the best possible strategy to minimize impact and improve patient quality of life.

Concurrent rectal perforation and obstruction following neoadjuvant chemoradiation for locally advanced rectal cancer: A case report

“…Diarrhea is the most common presenting symptom, usually resolving on its own after treatment cessation or completion. Significant bleeding necessitating intervention is uncommon, and acute perforation is very rare unless linked to the treatment response or progression of rectal cancer [ 7 ].…”

“…Most commonly associated with radiotherapy for prostate cancer, patients with chronic radiation proctitis can experience acute episodes of substantial rectal bleeding or present in outpatient setting with mild bleeding or iron deficiency anemia. This bleeding results from abnormal angiogenesis in the superficial layer of the lamina propria of the rectum, triggered by radiation-induced ischemia and fibrosis in the submucosa [ 7 ]. Symptom may mirror those of acute radiation proctitis, and patients might additionally suffer from complications like malabsorption, severe bleeding, stricture formation, perforations, fistulas, and bowel obstruction [ 6 ].…”