Jang H, Baek J G, Yoo S-J
1 Department of Radiation Oncology, Dongguk University School of Medicine, Gyeongju, Republic of Korea.
Br J Radiol. 2015 Jun;88(1050):20150022. doi: 10.1259/bjr.20150022. Epub 2015 Apr 15.
Patients with asymptomatic haemorrhoids are known to be less tolerant of radiation doses lower than known tolerance doses. In the present study, the authors sought to identify the risk factors of acute haemorrhoid aggravation after whole pelvic radiotherapy (WPRT).
The records of 33 patients with cervical, rectal or prostate cancer with asymptomatic haemorrhoids, which were confirmed by colonoscopy before the start of radiotherapy (RT), were reviewed. Acute anal symptoms, such as anal pain and bleeding, were observed up to 1 month after RT completion. Dosimetric and patient factors were analysed, and subgroup analyses were performed.
The median induction dose for acute anal symptoms was 34.1 Gy (range, 28.8-50.4 Gy). Post-operative treatment intent showed more acute anal toxicity of patient factors (p = 0.04). In subgroup analysis, post-operative treatment intent and concurrent chemoradiotherapy were found to be related to acute anal symptoms (p < 0.01). Of the dosimetric factors, V10 tended to be related to acute anal symptoms (p = 0.08).
This study indicates that asymptomatic haemorrhoid may deteriorate after low-dose radiation and that patient factors, such as treatment intent and concurrent chemotherapy, probably influence anal toxicity. In patients with asymptomatic haemorrhoids, WPRT requires careful dosimetry and clinical attention.
The tolerance of anal canal tends to be ignored in patients with pelvic cancer who are undergoing WPRT. However, patients with asymptomatic haemorrhoids may be troubled by low radiation doses, and further studies are required.
已知无症状痔患者对低于已知耐受剂量的辐射剂量耐受性较低。在本研究中，作者试图确定全盆腔放疗（WPRT）后急性痔加重的危险因素。
回顾了33例患有宫颈癌、直肠癌或前列腺癌且伴有无症状痔的患者的记录，这些患者在放疗（RT）开始前经结肠镜检查确诊。在RT完成后长达1个月的时间内观察急性肛门症状，如肛门疼痛和出血。分析剂量学和患者因素，并进行亚组分析。
急性肛门症状的中位诱导剂量为34.1 Gy（范围为28.8 - 50.4 Gy）。术后治疗意图显示患者因素的急性肛门毒性更大（p = 0.04）。在亚组分析中，发现术后治疗意图和同步放化疗与急性肛门症状相关（p < 0.01）。在剂量学因素中，V10倾向于与急性肛门症状相关（p = 0.08）。
本研究表明无症状痔在低剂量辐射后可能恶化，并且患者因素，如治疗意图和同步化疗，可能会影响肛门毒性。对于无症状痔患者，WPRT需要仔细的剂量测定和临床关注。
在接受WPRT的盆腔癌患者中，肛管的耐受性往往被忽视。然而，无症状痔患者可能会受到低辐射剂量的困扰，需要进一步研究。
