Anorectal function after modern conformal radiation therapy for prostate cancer: a pilot study |
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Authors: | Berndtsson I Lennernäs B Hultén L |
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Institution: | Institute for Surgical Science, Sahlgrenska University Hospital, SE-413 45 G?teborg, Sweden. |
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Abstract: | We evaluated whether, and if so to what extent, radiotherapy applied on a series of patients with prostate cancer influenced
the patient's bowel habits and anorectal function. Ten consecutive patients participated in the study. The median age of the
patients was 74 years (range, 61–71) and the average follow-up period was 22 (range, 15–28) months. Four patients were irradiated
using external beam radiotherapy (2 Gy/day for a total of 70 Gy); 6 patients were irradiated with a combination of external
beam radiotherapy (50 Gy, 2 Gy/day) and high dose rate brachytherapy (two 10-Gy fractions). Upon interview, patients disclosed
characteristic functiona disturbances such as urgency with occasional accidents, faecal soiling and spotting of underwear.
Involuntary release of gas was another embarrassing problem. One or more of these problems were present in half of the patients.
Endoscopy disclosed signs of mild proctitis. Sphincter pressure, rectal capacity and the volume threshold for appreciation
of defecation urge were all significantly lower in patients than in 10 age-matched controls. In conclusion, disturbances of
anorectal function with imperfection of incontinence still occur so some extent despite improved precision, and reduced margins
offered by the modern conformal radiation therapy of prostate cancer. Anal sphincter function, the reservoir capacity of the
rectum and its sensory function are adversely affected and radiation proctitis with rectal fibrosis and damage of the extrinsic
innervations of the anal sphincters appear to be the principal causative factors. Although conformal radiotherapy together
with better positioning may be two substantial improvements of modern radiotherapy, further improvements are needed.
Received: 11 May 2002 / Accepted: 12 June 2002
Correspondence to L. Hultén |
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Keywords: | Prostate cancer Radiation treatment Anorectal function Rectoanal manovolumetry |
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