Phan Jack, Swanson David A, Levy Lawrence B, Kudchadker Rajat J, Bruno Teresa L, Frank Steven J
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Cancer. 2009 May 1;115(9):1827-39. doi: 10.1002/cncr.24223.
This review of the literature on late rectal complications after prostate brachytherapy indicated that it is a highly effective treatment modality for patients with clinically localized prostate cancer but can cause chronic radiation proctitis. The most common manifestation of chronic radiation proctitis was anterior rectal wall bleeding, which often occurred within the first 2 years after brachytherapy. It is interesting to note that the rates of late rectal morbidity appear to have declined over time, which may reflect improvements in implantation techniques and imaging. Rectal biopsy as part of the workup to evaluate rectal bleeding can lead to rectal fistula and the need for colostomy, a rare but major complication. The authors recommend 1) screening colonoscopy before brachytherapy for patients who have not had a screening colonoscopy within the preceding 3 years to rule out colorectal malignancies and, thus, facilitate conservative management should rectal bleeding occur; 2) lifestyle modifications during treatment to limit exposure of the rectum to radiation; and 3) conservative management for rectal bleeding that occurs within 2 years after brachytherapy. Cancer 2009. (c) 2009 American Cancer Society.
这篇关于前列腺近距离放射治疗后直肠晚期并发症的文献综述表明，对于临床局限性前列腺癌患者，它是一种高效的治疗方式，但可能导致慢性放射性直肠炎。慢性放射性直肠炎最常见的表现是直肠前壁出血，通常发生在近距离放射治疗后的头两年内。值得注意的是，直肠晚期发病率似乎随着时间推移有所下降，这可能反映了植入技术和成像技术的改进。作为评估直肠出血检查一部分的直肠活检可导致直肠瘘以及需要进行结肠造口术，这是一种罕见但严重的并发症。作者建议：1）对于在过去3年内未进行过结肠镜筛查的患者，在近距离放射治疗前进行结肠镜筛查，以排除结直肠恶性肿瘤，从而在发生直肠出血时便于采取保守治疗；2）治疗期间改变生活方式，限制直肠受辐射暴露；3）对近距离放射治疗后2年内发生的直肠出血采取保守治疗。《癌症》2009年。（c）2009美国癌症协会。
