Introduction The chronic gastrointestinal (GI) side effects of pelvic radiotherapy (RT) can significantly impact on patients quality of life. The survival rates of many cancers are improving due to advances in multimodality therapies; consequently there is an emergent population of patients living with the long term side effects of their treatment. Our aim was to determine the prevalence of GI symptoms amongst patients treated with pelvic RT in a regional oncology centre (Velindre Hospital, Cardiff).
Methods A search of the Cancer Network Information System Cymru (CANISC) database identified patients who had received radical radiotherapy for gynaecological, colorectal or urological malignancy between 1/1/08 and 30/6/08. This period was chosen to allow a reasonable time to lapse for the majority of chronic radiotherapy side effects to be present. Case notes were reviewed to ascertain patient demographics, treatment plans and symptoms reported. GI symptoms reported ≥3 months after the end of RT were included. Rates of toxicity were compared to those reported in BSG guidance.1
Results 295 patients (218 male) received radical pelvic RT. GI symptoms were recorded in 31% of patients. 9% described more than one symptom up to 4 years post-treatment. No particular malignancy site, age or gender experienced significantly more GI symptoms (p > 0.05, Fisher exact, two tailed). Rates of potential toxicity were comparable to the BSG guidance for gynaecological (37.3% vs 40% respectively) and urological (28.7% vs 30%) malignancy.1 GI symptoms in the colorectal group were less than the BSG guidance (31.3 vs 66% > short course RT and 50% > chemo-radiation and surgery). The most prevalent symptoms were diarrhoea amongst gynaecological and colorectal patients and rectal bleeding amongst patients who had received treatment for prostatic carcinoma.
Conclusion A significant proportion of patients experience GI symptoms, which may be due to pelvic RT. We are likely to have underestimated reported symptoms, as data was taken from case notes rather than prospective patient questionnaires. Our overall prevalence and distribution of chronic GI symptoms in radical pelvic radiotherapy patients is similar to that stated in the literature. The majority of existing data on this subject is from one centre (Royal Marsden Hospital). As our data is similar to their reported data it is likely that it is a true reflection of the problem nationally. Only a minority of patients have previously been referred to gastroenterologists – this has increased and will continue to do so because of awareness raised by the BSG guidance.1
Disclosure of Interest None Declared.
Andreyev HJN, et al. Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer. Gut 2012; 61(2):179–92.