Long-term prognosis in patients with severe late radiation enteropathy: a prospective cohort study

Abstract

Aim: To assess persistent symptoms and mortality in a cohort of patients with severe (grade 3-4) radiation enteropathy, 59 patients were followed up after 15-18 years.

Methods: Fifty-nine patients were prospectively enrolled by twelve surgical departments. Primary malignant disease, radiation therapy and surgical management were recorded at inclusion. The cause of death or persistence of symptoms was examined in public death records or by interview of survivors.

Results: Thirty-nine patients had received radiation therapy for gynaecological cancers, twelve for urological cancers, four for gastrointestinal cancers and four for other malignancies. Forty-five patients (76%) required surgical intervention. Complications occurred in 11 (25%) operated patients. Forty-seven patients had died at the time of follow-up, seven (12%) died as a direct result of radiation enteropathy, while radiation enteropathy contributed to death in an additional seven patients. Four of the twelve surviving patients suffered from chronic debilitating symptoms of radiation enteropathy, while three had moderate symptoms.

Conclusion: Patients with severe delayed radiation enteropathy have a high risk of persistence of symptoms after surgery. At least one in ten patients dies from radiation-induced bowel injury.

Figure 1

Photomicrograph of colonic resection specimen, taken with a light microscope (HE, x 10). The image shows mucosa and submucosa. There is partial mucosal necrosis with significant loss of tissue architecture in the mucosa. In the lower right part of the picture, the mucosa is more intact. The submucosa shows fibrosis and a patchy chronic inflammation in the form of aggregates of lymphocytes.