Radiation induced Proctocolitis - Risk factors and Correlation of Symptoms with Colonoscopy.

Aravind, A (2006) Radiation induced Proctocolitis - Risk factors and Correlation of Symptoms with Colonoscopy. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Although over a century has elapsed since the first description of deleterious effects of radiation on normal tissues , such effects remain the principle limitation of radiotherapy. Although current powerful radiation sources could be effective in destroying most, if not all, tumors, no ideal method exists to deliver radiation to cancer exclusively and spare normal tissues. Radiation is used as part of treatment in more than half of all cancer patients . Incidence of severe radiation-related complications is difficult to determine, long periods of follow up are required. Local symptoms may be underestimated, because physicians and patients may be more concerned with metastatic disease or immediately lifethreatening conditions. Compared to studies that address the efficacy of radiotherapy, few studies exist in which complications are approached methodically and as the primary focus. Nevertheless, radiation damage to normal tissues can be costly and have not only a major impact on quality of life but also on overall survival. Rather than discussing benefits of radiotherapy, this thesis article reviews radiation damage to normal tissues, including basic science aspects, and focuses on the most severe anorectal complications of radiotherapy. Recognition and treatment of associated lesions, including cancer recurrence, are crucial for obtaining satisfactory results. BACKGROUND : Cancer cervix is the most common type of cancer in Indian women and can cause significant morbidity and mortality. With the wide spread use of screening programs the incidence of advanced carcinoma in reduced, though we still could find large number of patients are being referred to tertiary medical care facility with advanced lesions. One of the acknowledged treatment options for fairly advanced ca cervix beyond stage II A is radiotherapy (external beam as well as intracavity radiation). We see lot of patients being referred to medical gastroenterology department of Government General Hospital, Park Town Chennai with symptoms suggestive of radiation induced proctocolitis. Though the diagnosis of radiation induced proctocolitis is fairly easy and straight forward, the treatment is often elusive leaving the patients with considerable morbidity and reduced quality of life. The most important issue is the risk of malignancy in the radiated tissues of rectum and sigmiod colon which appears to be substantial. We undertook this study to identify the risk factors ( patients factors, disease factors, treatment regimen factors) for severity of bowel lesions. Also we tried to correlate clinically the risk of severe RPC to endoscopic severity. The biopsy specimen which was taken in suspicious sites were analysed for evidence of malignancy and to rule out other causes of rectal involvement. AIM OF THE STUDY : 1. Identification of risk factors in severe radiation induced proctocolitis in patients treated for advanced Ca cervix by radiotherapy. 2. To correlate the identified risk factors with that of endoscopic severity. 3. To find out the occurrence of adenocarcinoma of rectum and distal large bowel in patients who has radiation proctocolitis. CONCLUSIONS : 1. The incidence and severity of radiation induced damage to colonic mucosa was influenced by patient factors : age, presence of co-morbidities, low BMI, anemia, long duration of symptoms, disease factors :stage III b disease, treatment factors : total radiation dose, brachytherapy. 2. The clinical assessment of patients with the above risk factors is strong predictor of severe lesions at colonoscopy 3. The risk of malignancy after radiation therapy in the affected colonic mucosa in extremely rare and routine surveillance for the detection of the same is not required.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Radiation ; Proctocolitis ; Risk factors ; Correlation of Symptoms ; Colonoscopy.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:03
Last Modified: 13 Jul 2017 04:03
URI: http://repository-tnmgrmu.ac.in/id/eprint/1550

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