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Healing of Late Endoscopic Changes in the Rectum between 12 and 65 Months after External Beam Radiotherapy

Heilung von Schleimhautveränderungen im Rektum zwischen 12 und 65 Monaten nach externer Strahlentherapie

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Abstract

Purpose:

To evaluate the time course of late rectal mucosal changes after prostate cancer radiotherapy (RT).

Patients and Methods:

A rectosigmoidoscopy was performed at 12, 24, and 65 months after RT in 20 patients. Rectal mucosal changes (telangiectasia, congested mucosa, ulceration, stricture, and necrosis) were scored and documented according to the Vienna Rectoscopy Score (VRS, score 0–3).

Results:

VRS of 0 and 3, were found in 20% of patients (n = 4) and 5% of patients (n = 1), respectively at all time points. A shift of the VRS from 2 to 1 was found with incidence rates of 60% at 12 months and 20% at 65 months, which is equivalent to an improvement rate of 67%. Laser coagulation was required in 3 patients (15%) with rectal bleeding due to telangiectasia grade ≥2.

Conclusion:

Late rectal mucosal changes are frequent after pelvic RT. Generally only the incidence rates corresponding to the initial diagnosis of the complications, independent of subsequent recovery, are reported. The results reported in the present study show that complications often improve over time. Hence, the usual reports of complication rates overestimate the proportion of patients presenting with side effects of certain grades.

Zusammenfassung

Hintergrund:

Wie entwickeln sich Schleimhautveränderungen am Rektum nach Radiotherapie des Prostatakarzinoms im zeitlichen Verlauf?

Patienten und Material:

Bei 20 Patienten wurde 12, 24 und 65 Monate nach RT eine Rektosigmoidoskopie durchgeführt. Rektale Schleimhautveränderungen wurden bewertet und entsprechend dem Wiener Rektoskopie-Score (VRS, Score 0–3) graduiert.

Ergebnisse:

Ein VRS-Score 0 und -Score 3 wurde bei 20% (4 Patienten) und bei 5% (1 Patient) zu jedem Zeitpunkt nach RT erhoben. Eine Verlagerung von VRS-Score 2 zu -Score 1 mit einer Inzidenzrate von 60% nach 12 Monaten und 20% nach 65 Monaten wurde nachgewiesen, entsprechend einer Verbesserung bei 67% der Patienten (Tabelle 2). Bei 3 Patienten (15%) wurde eine Laser-Koagulation aufgrund rektaler Blutungen mit Teleangiektasien Grad ≥2 durchgeführt.

Schlussfolgerung:

Rektale Schleimhautveränderungen nach RT des Beckens treten häufig auf. In der Regel werden lediglich die Inzidenzraten entsprechend dem erstmaligen Auftreten dokumentiert, unabhängig davon ob eine Verbesserung der Veränderungen, wie in dieser Arbeit nachgewiesen, eintritt. Durch diese Art der Präsentation wird der Anteil an Patienten mit einem bestimmten Schweregrad von Nebenwirkungen oftmals überschätzt.

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Authors and Affiliations

  1. Department of Radiotherapy and Radiobiology, Vienna General Hospital, University of Vienna Medical School, Vienna, Austria

    Gregor Goldner, Richard Pötter, Alexander Kranz, Alexandra Bluhm & Wolfgang Dörr

  2. Department of Radiotherapy and Radiation Oncology, Medical Faculty Carl Gustav Carus, University of Technology Dresden, Dresden, Germany

    Wolfgang Dörr

  3. Klinik für Strahlentherapie, Medizinische Universität Wien, Währinger Gürtel 18–20, Vienna 1090, Austria

    Gregor Goldner

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  1. Gregor Goldner
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  2. Richard Pötter
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  3. Alexander Kranz
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  4. Alexandra Bluhm
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  5. Wolfgang Dörr
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Correspondence to Gregor Goldner.

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Goldner, G., Pötter, R., Kranz, A. et al. Healing of Late Endoscopic Changes in the Rectum between 12 and 65 Months after External Beam Radiotherapy. Strahlenther Onkol 187, 202–205 (2011). https://doi.org/10.1007/s00066-010-2211-5

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  • DOI: https://doi.org/10.1007/s00066-010-2211-5

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