Late progress of radiation-induced proctitis.

Sixty-five patients with late radiation-induced proctitis who presented after a median latency of 13 months (range 6 months to 43 years) were studied retrospectively. As a result of progression new colorectal injuries had occurred in 53 patients (82%): stricture (n = 33), fistula (n = 19) and perforation (n = 1). Fourty-one patients had progression of their lesions to the small bowel or urinary tract. Only seven patients had no progression of their radiation injuries after the initial episode proctitis. Surgery was required in 15 patients with strictures, in 18 patients with fistulas, and in one patient with perforation. Thirty-two patients were managed conservatively. Fifteen patients died, given an overall radiation induced mortality of 23%. Factors significantly influencing mortality were coexisting injuries of the small bowel or urinary tract. Age, stage of primary malignant disease, and previous laparotomy did not influence outcome. After a median observation period of 11 years, 35 patients were alive, of whom 18 (51%) had a fair outcome; 12 continued to have slight or moderate symptoms (34%) and five disabling symptoms (14%). Ten patients had died from unrelated causes, and five from recurrent cancer. Because radiation-induced proctitis is likely progresses, it can not be characterised as a harmless manifestation of late radiation injuries.