Chang Bianca W, Kumar Aryavarta M S, Koyfman Shlomo A, Kalady Matthew, Lavery Ian, Abdel-Wahab May
Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA,
Int J Colorectal Dis. 2015 Mar;30(3):403-8. doi: 10.1007/s00384-014-2103-8. Epub 2015 Jan 8.
The effects of radiotherapy are debated in inflammatory bowel disease (IBD). We examined IBD patients with colorectal cancer (CRC) and compared those who underwent external beam radiation therapy (EBRT) to those who did not. We then compared those same patients treated with EBRT to similarly treated non-IBD patients to ascertain differences in toxicity and perioperative outcomes.
Fifty-seven IBD patients with CRC received EBRT, of which 23 had perioperative follow-up and 15 had complete records. The 23 patients were compared to 229 IBD patients with CRC who did not receive EBRT. The 15 patients were matched, 1:2, to similarly treated non-IBD patients with CRC based on age (±5 years), treatment year (±1 year), BMI (±10 kg/m2), and clinical stage.
There was significantly more postoperative bleeding (5.3 % vs. 0 %, p < 0.01), wound dehiscence (3.5 % vs. 0 %, p < 0.01), and perineal infection (8.8 % vs. 1.3 %, p < 0.01) in IBD patients with EBRT compared to those without EBRT. IBD patients were significantly more likely to have grade 3 or higher lower GI toxicity (40 % vs. 7 %, p = 0.02) and wound dehiscence (36 % vs. 7 %, p = 0.02) than non-IBD patients, however without significant difference in bleeding, infection, ileus, or survival.
IBD patients with CRC who received EBRT were more likely than similar patients without EBRT to experience perioperative complications. These patients also experienced more lower GI toxicity than similarly treated non-IBD patients with CRC. The expected decrease in survival in IBD-associated CRC was not observed. Thus, EBRT may contribute to a survival benefit in this group.
放射治疗在炎症性肠病（IBD）中的作用存在争议。我们研究了患有结直肠癌（CRC）的IBD患者，并将接受体外放射治疗（EBRT）的患者与未接受该治疗的患者进行比较。然后，我们将接受EBRT治疗的这些患者与接受类似治疗的非IBD患者进行比较，以确定毒性和围手术期结果的差异。
57例患有CRC的IBD患者接受了EBRT，其中23例进行了围手术期随访，15例有完整记录。将这23例患者与229例未接受EBRT的患有CRC的IBD患者进行比较。根据年龄（±5岁）、治疗年份（±1年）、体重指数（±10 kg/m²）和临床分期，将这15例患者按1:2的比例与接受类似治疗的患有CRC的非IBD患者进行匹配。
与未接受EBRT的IBD患者相比，接受EBRT的IBD患者术后出血（5.3%对0%，p<0.01）、伤口裂开（3.5%对0%，p<0.01）和会阴感染（8.8%对1.3%，p<0.01）的发生率明显更高。与非IBD患者相比，IBD患者发生3级或更高等级的下消化道毒性（40%对7%，p=0.02）和伤口裂开（36%对7%，p=0.02）的可能性明显更高，然而在出血、感染、肠梗阻或生存率方面没有显著差异。
接受EBRT的患有CRC的IBD患者比未接受EBRT的类似患者更有可能经历围手术期并发症。这些患者比接受类似治疗的患有CRC的非IBD患者经历的下消化道毒性也更多。未观察到IBD相关CRC患者预期的生存率下降。因此，EBRT可能对该组患者的生存有益。
