RADIATION INDUCED ENTEROCOLITIS

Abstract

Radiation is among the first choice of treatments for pelvic malignancies such as prostate and uterine cancer. However, radiation also induces acute and chronic side effects on the small and large bowels including hemorrhagic sigmoidproctitis, ulcer, stenosis and fistula formation. Bloody stools is the most frequent symptom of chronic radiation-induced enterocolitis, followed by defecation disorder and anal pain. Classification for radiation-induced enterocolitis is based on the time course, severity and pathology. It is mandatory to understand these classifications precisely in order to devise a proper treatment strategy for this disease. Although there has been no established guideline for treatment of radiation-induced hemorrhage, many authors have reported the effectiveness of an endoscopic approach. In particular argon, plasma coagulation is an easy, safe and effective treatment. On the other hand radiation-induced enterocolitis with ulcer formation is associated with a very fragile mucosa and therefore a more appropriate treatment should be a topical enema which is effective on both the hemorrhage and ulcer rather than the endoscopic approach. Hyperbaric oxygen therapy is a promising approach for radiation-induced bowel perforation and stenosis. Surgery is sometimes effective for radiation-induced fistula and stenosis, but its indication should be carefully examined because surgery is also accompanied by a high morbidity rate.