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Review
. 2023 Apr 9;15(8):2214.
doi: 10.3390/cancers15082214.

Rectal Cancer after Prostate Radiation: A Complex and Controversial Disease

Dana M Omer  1 , Hannah M Thompson  1 , Floris S Verheij  1 , Jonathan B Yuval  1 , Roni Rosen  1 , Nathalie R A Beets  1 , Anisha Luthra  2 , Paul B Romesser  3 , Philip B Paty  1 , Julio Garcia-Aguilar  1 , Francisco Sanchez-Vega  1   2
Affiliations
Review

Rectal Cancer after Prostate Radiation: A Complex and Controversial Disease

Dana M Omer et al. Cancers (Basel). .

Abstract

A small proportion of rectal adenocarcinomas develop in patients many years after the treatment of a previous cancer using pelvic radiation, and the incidence of these rectal cancers depends on the length of follow-up from the end of radiotherapy. The risk of radiation-associated rectal cancer (RARC) is higher in patients treated with prostate external beam radiotherapy than it is in patients treated with brachytherapy. The molecular features of RARC have not been fully investigated, and survival is lower compared to non-irradiated rectal cancer patients. Ultimately, it is unclear whether the worse outcomes are related to differences in patient characteristics, treatment-related factors, or tumor biology. Radiation is widely used in the management of rectal adenocarcinoma; however, pelvic re-irradiation of RARC is challenging and carries a higher risk of treatment complications. Although RARC can develop in patients treated for a variety of malignancies, it is most common in patients treated for prostate cancer. This study will review the incidence, molecular characteristics, clinical course, and treatment outcomes of rectal adenocarcinoma in patients previously treated with radiation for prostate cancer. For clarity, we will distinguish between rectal cancer not associated with prostate cancer (RCNAPC), rectal cancer in non-irradiated prostate cancer patients (RCNRPC), and rectal cancer in irradiated prostate cancer patients (RCRPC). RARC represents a unique but understudied subset of rectal cancer, and thus requires a more comprehensive investigation in order to improve its treatment and prognosis.

Keywords: colorectal surgery; oncology; radiation; radiation oncology; radiation-associated rectal cancer; rectal cancer; surgical oncology.

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Conflict of interest statement

P.B.R. received research funding from K08 CA255574 (2019) and serves as a consultant for EMD Serono (2018–2022), receives research funding from XRAD Therapeutics (2022), and is a consultant for Natera (2022). J.G.-A. receives honorariums from Johnson & Johnson, Medtronic, and Intuitive Surgical and owns stock in Intuitive Surgical. D.M.O., H.M.T., F.S.V., J.B.Y., R.R., N.R.A.B., A.L., P.B.P. and F.S.-V. have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Interval endoscopies of a patient who refused treatment for RARC with disease progression. Over a period of one year, the tumor evolved from an ulcer along the anterior rectal wall.
Figure 2
Figure 2
Endoscopy from a patient whose lesion was arising from a background of rectal fibrosis. A biopsy of this lesion demonstrated fragments of adenocarcinoma.
Figure 3
Figure 3
(A) Endoscopic ultrasound of a uT3N0Mx radiation-associated rectal cancer along the anterior rectal wall. The yellow circle marks the tip of the ultrasound probe. (B) MRI of the rectum depicting a radiation-associated rectal cancer in a patient who underwent brachytherapy for prostate cancer. The yellow arrow marks the tumor.
See this image and copyright information in PMC

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