Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Pract Radiat Oncol. 2012 Jul-Sep;2(3):e7-e13. doi: 10.1016/j.prro.2011.11.010. Epub 2012 Jan 4.
To investigate the incidence of undiagnosed, asymptomatic synchronous colorectal cancer (CRC) by using screening colonoscopy before brachytherapy, and to compare the subsequent rates of CRC and rectal toxicity in this screened population with those rates in unscreened patients after brachytherapy.
Patient, disease, and treatment characteristics, including history of colonoscopy and CR malignancy, were extracted from the medical records of all men who had undergone brachytherapy as monotherapy for low- or intermediate-risk prostate cancer at a single tertiary cancer care center between January 2000 and December 2009. The frequency of biopsy or polypectomy at screening colonoscopy, incidence of CR malignancy before and after prostate cancer diagnosis, and rate of brachytherapy toxicity including rectal bleeding were compared between men who had had screening colonoscopy before brachytherapy and men who had not.
Of the 451 men identified, 268 had undergone screening colonoscopy during the 36 months before brachytherapy and 183 had not. Of the 268 men who had had screening colonoscopy, 117 (44%) underwent biopsy or polypectomy, and 6 (3.2%) were found to have asymptomatic CRC. After brachytherapy, CRC was diagnosed in 3 (1.6%) of the 183 men who had not had screening colonoscopy before treatment versus 0 of the 268 men who had had screening colonoscopy (P = 0.035). Rectal toxicity was more common and more severe among men who had not undergone screening colonoscopy compared with those who had had screening colonoscopy before brachytherapy (14% vs 6%, P = 0.003). More unscreened patients (18% vs 5%) underwent postbrachytherapy colonoscopy (P < 0.001), with the potential of subjecting the irradiated rectum to biopsy.
More than 3% of men with newly diagnosed prostate cancer in this study presented with undiagnosed, asymptomatic CRC, and the rate of postbrachytherapy rectal complications was higher among unscreened than among screened patients. We recommend screening colonoscopy for men who have not had CRC screening within the 3 years preceding prostate cancer diagnosis before radiation therapy to avoid unnecessary rectal biopsies and the associated risk of major complications.
通过在近距离放射治疗前进行筛查性结肠镜检查，研究未诊断的无症状同步结直肠癌（CRC）的发生率，并比较该筛查人群与近距离放射治疗后未经筛查患者的 CRC 和直肠毒性的后续发生率。
从 2000 年 1 月至 2009 年 12 月在单一的三级癌症治疗中心接受单纯近距离放射治疗的低危或中危前列腺癌男性患者的病历中提取患者、疾病和治疗特征，包括结肠镜检查和 CRC 恶性肿瘤史。比较在近距离放射治疗前进行筛查性结肠镜检查的男性与未进行该检查的男性的筛查性结肠镜检查时活检或息肉切除术的频率、前列腺癌诊断前后 CRC 恶性肿瘤的发生率以及包括直肠出血在内的近距离放射治疗毒性的发生率。
在确定的 451 名男性中，268 名男性在近距离放射治疗前的 36 个月内接受了筛查性结肠镜检查，183 名未接受检查。在接受了筛查性结肠镜检查的 268 名男性中，117 名（44%）接受了活检或息肉切除术，6 名（3.2%）发现患有无症状 CRC。在近距离放射治疗后，未接受治疗前筛查性结肠镜检查的 183 名男性中有 3 名（1.6%）诊断为 CRC，而接受了检查的 268 名男性中无 1 例（0%）（P=0.035）。与接受近距离放射治疗前接受了筛查性结肠镜检查的男性相比，未接受该检查的男性直肠毒性更常见且更严重（14%比 6%，P=0.003）。更多未接受筛查的患者（18%比 5%）接受了近距离放射治疗后的结肠镜检查（P<0.001），这可能会对放射治疗后的直肠进行活检。
在本研究中，超过 3%的新诊断为前列腺癌的男性患有未诊断的、无症状的 CRC，并且未接受筛查的患者的近距离放射治疗后直肠并发症发生率高于接受筛查的患者。我们建议在放射治疗前，对于在前列腺癌诊断前 3 年内未接受 CRC 筛查的男性进行筛查性结肠镜检查，以避免不必要的直肠活检和相关的严重并发症风险。
