Radiation therapy in patients with inflammatory bowel disease and colorectal cancer: Risks and benefits

Abstract

Purpose The effects of radiotherapy are debated in inflammatory bowel disease (IBD). We examined IBD patients with colorectal cancer (CRC) and compared those who underwent external beam radiation therapy (EBRT) to those who did not. We then compared those same patients treated with EBRT to similarly treated non-IBD patients to ascertain differences in toxicity and perioperative outcomes. Methods Fifty-seven IBD patients with CRC received EBRT, of which 23 had perioperative follow-up and 15 had complete records. The 23 patients were compared to 229 IBD patients with CRC who did not receive EBRT. The 15 patients were matched, 1:2, to similarly treated non-IBD patients with CRC based on age (±5 years), treatment year (±1 year), BMI (±10 kg/m2), and clinical stage. Results There was significantly more postoperative bleeding (5.3 % vs. 0 %, p<0.01), wound dehiscence (3.5 % vs. 0 %, p<0.01), and perineal infection (8.8 % vs. 1.3 %, p<0.01) in IBD patients with EBRT compared to those without EBRT. IBD patients were significantly more likely to have grade 3 or higher lower GI toxicity (40 % vs. 7 %, p=0.02) and wound dehiscence (36 % vs. 7 %, p=0.02) than non-IBD patients, however without significant difference in bleeding, infection, ileus, or survival.Conclusion IBD patients with CRC who received EBRT were more likely than similar patients without EBRT to experience perioperative complications. These patients also experienced more lower GI toxicity than similarly treated non-IBD patients with CRC. The expected decrease in survival in IBDassociated CRC was not observed. Thus, EBRT may contribute to a survival benefit in this group.

Stereotactic body radiation therapy for the treatment of localized prostate cancer in men with underlying inflammatory bowel disease

“…Importantly, all patients who developed high-grade late toxicity underwent rectal biopsies shortly after brachytherapy implant. Similar high-grade toxicity was observed in patients with IBD treated with EBRT for colorectal cancer in the peri-operative setting [29]. These studies allude to an augmented toxicity risk with surgical manipulation of the pelvis in IBD cases following radiation, and highlight the importance of avoiding elective rectal interventions shortly after radiotherapy regardless of the presence of underlying bowel disease.…”

Colon Cancer

“…A dose-volume relationship between amount of small bowel exposed to/receiving low and intermittent doses of radiation and rate of severe diarrhea have been reported 67,68 . However, such short-term toxicities do not outweigh the increase in survival benefit 69 .…”

Use of biologics and chemotherapy in patints with inflammatory bowel diseases and cancer

“…A single-center study of IBD and non-IBD patients with CRC has recently compared: the perioperative complications in IBD patients who received and did not receive abdominopelvic radiation therapy with IBD patients with CRC who did not receive it; the acute radiation toxicity of abdominopelvic radiation therapy between IBD patients and non-IBD patients with CRC [ 81 ]. There was significantly more postoperative bleeding, wound dehiscence, and perineal infection in the group of IBD patients who received EBRT compared with IBD patients without EBRT.…”