Association between acute histopathological changes of rectal walls and late radiation proctitis following radiotherapy for prostate cancer

High-risk factors and predictive models for hemorrhagic chronic radiation proctitis

INTRODUCTION

Hemorrhagic chronic radiation proctitis (CRP) is a common and challenging complication after pelvic radiation therapy. Identifying high-risk factors, predicting its occurrence, and optimizing radiotherapy plans are key to preventing hemorrhagic CRP. This study retrospectively examined potential risk factors and developed a nomogram to predict its onset.

METHODS

This retrospective study included cervical carcinoma patients who received pelvic radiotherapy at Chongqing University Cancer Hospital from March 2014 to December 2021. Hemorrhagic CRP was diagnosed by colonoscopy. Logistic regression identified factors for a nomogram model, which was evaluated using ROC curve, calibration curve, and decision curve analysis.

RESULTS

Among 221 patients, 125 were diagnosed with hemorrhagic CRP, occurring at a median of 14.45 months after pelvic radiotherapy. Age (≥ 54 years), weight (< 52 kg), and radiation dose (≥ 72 Gy) were identified as risk factors. A nomogram was developed, with AUC values of 0.741 and 0.74 in the training and validation cohorts. Decision and clinical impact curves showed the model's benefit over a probability range of 0.25 to 0.85 in both sets.

CONCLUSION

In this study, we constructed and developed a nomogram for predicting hemorrhagic CRP risk. The good results in calibration curves, ROC curve analysis, and decision curves indicated that the nomogram had promise for clinical application. It may serve as a reference for radiologists in designing radiotherapy plan to help mitigate the risk of hemorrhagic CRP.

Start Early and See Inflammatory; Late, Nothing Save RAVE: How to Appreciate Radiation Proctitis as a Continuum

Background and Aims

It has been recently proposed to change the nomenclature of "chronic radiation proctitis" (CRP) to "radiation-associated vascular ectasia" on the basis that signs of inflammation are rarely observed. We herein present data supporting the idea that inflammation is a critical step that initiates the process that culminates in the characteristic changes of CRP.

Methods

In support of inflammation in the pathogenesis of CRP, we review the pertinent literature and publish our new results, including the role of amifostine treatment and proinflammatory factors (p38 MAP kinase, VEGF, and CEACAM1).

Results

Immunohistochemistry from anterior rectal wall biopsies obtained in a prospective pilot study demonstrates that expression of VEGF and the downstream vascular effector CEACAM1 were elevated before radiotherapy and declined with time. We also show that MAP Kinase p38 expression usually precede the radiation. Fibrosis scores increase from baseline at 9 and 18 months, while vascular scores decrease at 18 months.

Conclusion

The proposed new nomenclature should be held in obeyance until more supportive data are presented. Possibly, the best way to view CRP is as a continuum that may take one of three forms, inflammation-predominant, vasculopathy-predominant, or mixed.

Prostate radiotherapy and the risk of secondary rectal cancer-a meta-analysis

PURPOSE

Radiotherapy is being used increasingly in the treatment of prostate cancer. However, ionising radiation may confer a small risk of a radiation-induced secondary malignancy. We aim to assess the risk of rectal cancer following pelvic radiotherapy for prostate cancer.

METHODS

A search was conducted of the PubMed/MEDLINE, EMBASE and Web of Science databases identifying studies reporting on the risk of rectal cancer following prostatic radiotherapy. Studies must have included an appropriate control group of non-irradiated prostate cancer patients. A meta-analysis was performed to assess the risk of prostatic radiotherapy on subsequent rectal cancer diagnosis.

RESULTS

In total, 4757 articles were screened with eight studies meeting the predetermined criteria. A total of 796,386 patients were included in this meta-analysis which showed an increased odds ratio (OR) for subsequent rectal cancer in prostate cancer patients treated with radiotherapy compared to those treated by non-radiotherapy means (OR 1.45, 1.07-1.97, p = 0.02).

CONCLUSION

These findings confirm that prostate radiotherapy significantly increases the risk of subsequent rectal cancer. This risk has implications for treatment selection, surveillance and patient counselling. However, it is crucial that this information is presented in a rational and comprehensible manner that does not disproportionately frighten or deter patients from what might be their most suitable treatment modality.

Radiotherapy-Induced Digestive Injury: Diagnosis, Treatment and Mechanisms

Radiotherapy is one of the main therapeutic methods for treating cancer. The digestive system consists of the gastrointestinal tract and the accessory organs of digestion (the tongue, salivary glands, pancreas, liver and gallbladder). The digestive system is easily impaired during radiotherapy, especially in thoracic and abdominal radiotherapy. In this review, we introduce the physical classification, basic pathogenesis, clinical characteristics, predictive/diagnostic factors, and possible treatment targets of radiotherapy-induced digestive injury. Radiotherapy-induced digestive injury complies with the dose-volume effect and has a radiation-based organ correlation. Computed tomography (CT), MRI (magnetic resonance imaging), ultrasound (US) and endoscopy can help diagnose and evaluate the radiation-induced lesion level. The latest treatment approaches include improvement in radiotherapy (such as shielding, hydrogel spacers and dose distribution), stem cell transplantation and drug administration. Gut microbiota modulation may become a novel approach to relieving radiogenic gastrointestinal syndrome. Finally, we summarized the possible mechanisms involved in treatment, but they remain varied. Radionuclide-labeled targeting molecules (RLTMs) are promising for more precise radiotherapy. These advances contribute to our understanding of the assessment and treatment of radiation-induced digestive injury.

A Ten-year-long Update on Radiation Proctitis Among Prostate Cancer Patients Treated With Curative External Beam Radiotherapy

This comprehensive synopsis summarizes the most relevant information obtained from a systematic analysis of studies of the last decade on radiation proctitis, one of the most feared radioinduced side effects among prostate cancer patients treated with curative external beam radiotherapy. The present review provides a useful support to radiation oncologists for limiting the onset or improving the treatment of radiation proctitis. This work shows that the past decade was a harbinger of significant new evidence in technological advances and technical tricks to avoid radiation proctitis, in addition to dosimetric perspectives and goals, understanding of pathogenesis, diagnostic work-up and treatment. We believe that a well-rounded knowledge of such an issue is fundamental for its appropriate management.

Proktitis (ohne chronisch-entzündliche Darmerkrankung)

Vermehrter Stuhldrang, Schleim‑/Blutabgänge sowie Läsionen an der Mukosa und ödematöse Veränderungen sind typische Beschwerden von Patienten mit Proktitis. Die Symptomatik und häufig auch die klinische Präsentation der Proktitiden sind nicht selten unspezifisch bzw. ähnlich und bedürfen aufgrund der drohenden Komplikationen mit Lebensqualitätseinschränkung einer guten Anamnese und des Wissens um die vielfältigen Ursachen. Man muss die Differenzialdiagnosen kennen, um sie auch erkennen zu können. Unser Fallbeispiel zeigt die Tücken einer vermeintlich leichten Diagnostik. Im vorliegenden Beitrag werden fast alle Proktitiden außer jener der chronisch-entzündlichen Darmerkrankungen beschrieben.