Radiation Proctitis and Management Strategies

Abstract

Radiotherapy (RT) is a treatment modality that uses high-energy rays or radioactive agents to generate ionizing radiation against rapidly dividing cells. The main objective of using radiation in cancer therapy is to impair or halt the division of the tumor cells. Over the past few decades, advancements in technology, the introduction of newer methods of RT, and a better understanding of the pathophysiology of cancers have enabled physicians to deliver doses of radiation that match the exact dimensions of the tumor for greater efficacy, with minimal exposure of the surrounding tissues. However, RT has numerous complications, the most common being radiation proctitis (RP). It is characterized by damage to the rectal epithelium by secondary ionizing radiation. Based on the onset of signs and symptoms, post-radiotherapy RP can be classified as acute or chronic, each with varying levels of severity and complication rates. The treatment options available for RP are limited, with most of the data on treatment available from case reports or small studies. Here, we describe the types of RT used in modern-day medicine and radiation-mediated tissue injury. We have primarily focused on the classification, epidemiology, pathogenesis, clinical features, treatment strategies, complications, and prognosis of RP.

Keywords: Colorectal Neoplasms; Proctitis; Radiation; Rectum.

Fig. 1.

Endoscopic findings of acute radiation proctitis. Rectal mucosa shows erythema, petechiae and bleeding. Adapted from the article of Katsanos KH et al. Ann Gastroenterol 2012;25:65, with permission.

Fig. 2.

Endoscopic finding of chronic radiation proctitis. Rectal mucosa shows telangiectasias. Adapted from the article of Zhong Q-H et al. World J Gastroenterol 2019;25:1618-1627, with permission.

Fig. 3.

Treatment algorithm for radiation proctitis in accordance with the American Society of Colon and Rectal Surgeons.