Radiation Therapy and Malignant Fistulae of Anorectal Cancers |
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| Affiliation: | 1. Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland;2. Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland;3. University of Maryland School of Medicine, Baltimore, Maryland;4. Department of Medical Oncology, University of Maryland School of Medicine, Baltimore, Maryland;5. Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland;6. Division of Radiation Oncology, University of Tennessee Medical Center, Knoxville, Tennessee;1. Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada;2. Department of Anatomy, University of California San Francisco, San Francisco, California;3. Department of Radiation Oncology, Rush University Medical Centre, Chicago, Illinois;4. Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada;5. Department of Medical Imaging, St. Joseph''s Health Care, London, Ontario, Canada;6. Department of Radiation Oncology, Odette Cancer Centre, Toronto, Ontario, Canada;7. Department of Otolaryngology–Head and Neck Surgery, London Health Sciences Centre, London, Ontario, Canada;8. Department of Radiology, London Health Sciences Centre, London, Ontario, Canada;9. Department of Physiology and Pharmacology, Western University, London, Ontario, Canada;1. Department of Radiation Oncology, Anderson Regional Health System, Meridian, Mississippi;2. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York;1. Department of Radiation Oncology, New York University Grossman School of Medicine, New York, New York;2. Blood and Marrow Transplantation Program, NYU Langone Health, New York, New York;1. Department of Radiation Oncology, Ascension St. Vincent''s East, Birmingham, Alabama;2. Department of Radiation Oncology, Anderson Regional Health System, Meridian, Mississippi;1. Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan;2. Oakland University William Beaumont School of Medicine, Rochester, Michigan;1. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota;2. Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey;3. Department of Surgery, Mayo Clinic, Rochester, Minnesota |
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| Abstract: | ![]()
PurposeAlthough fistulization is a well-studied late toxic effect of radiation therapy (RT), anorectal cancers (ARCs) can present with malignant fistulae (MF) and negatively affect quality of life. The effect of RT, often combined with concurrent chemotherapy, on MF needs systematic analysis, because practitioners are concerned that RT may exacerbate MF. We reviewed our institutional series evaluating the hypothesis that RT worsens MF.Methods and MaterialsA single-institutional retrospective analysis of patients with ARC receiving RT from 2006 to 2019 was performed. These patients were screened for MF. Any MF resected before RT and RT not directed at the site of MF were excluded. Effects were assessed by review of available follow-up documentation and imaging.ResultsA total of 639 patients with ARC were reviewed, and 47 had MF (7.4%). With a median follow-up of 22 months (range, 2-133 months), RT improved MF in 17 of 29 evaluable patients (59%), with 9 of 29 (31.0%) having resolution. The median time to improvement was 50 days (range, 25-117 days); the median duration of improvement was 161 days (range, 0-1941 days). Malignant fistulae persisted in 12 of 29 patients (41%), with persistent local disease in all cases; in 2 cases, MF worsened concomitant with local progression.ConclusionsIn all, 7.4% of patients with ARC presented with MF. Radiation therapy led to improvement or resolution in more than half of evaluable patients. Persistence or worsening of MF was only observed in patients with refractory or progressive local disease. Based on our findings, MF is not a contraindication to RT and may be considered as an independent indication for palliative RT. |
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