Department of Microbiology, School of Medicine, Dongguk University, Gyeongju, Republic of Korea.
Department of Radiation Oncology, School of Medicine, Dongguk University, Gyeongju, Republic of Korea
In Vivo. 2021 Jul-Aug;35(4):2357-2361. doi: 10.21873/invivo.12512.
BACKGROUND/AIM: Anal canal toxicity tends to be ignored in pelvic radiotherapy (RT). However, patients with hemorrhoids can be troubled by lower radiation dose. We tried to determine whether a correlation exists between hemorrhoids and anal symptoms in patients with cervical cancer undergoing RT.
The insurance claim data of patients who underwent definitive treatment for cervical cancer from 2015 to 2019 were analyzed. Adverse events including bleeding, proctitis, and hemorrhoids, were documented for 1 year after treatment completion. Odds ratios (ORs) were estimated by unconditional Poisson regression and adjusted for age, treatments, chemotherapy, and comorbidities.
Details of 67,114 insured cervical cancer patients treated between 2015 and 2019 were obtained. Among them, 5,919 patients with follow-up data for at least one year, treated with curative intent, were analyzed. The OR of the definitive radiotherapy group (DRT group) for anal bleeding was 10.57 higher than that of the operation alone group (surgical group) (p<0.01). Newly developed hemorrhoids gradually increased in the surgical group (3.17%), the postoperative radiotherapy group (5.38%), and the DRT group (7.58%). The OR of the DRT group for newly developed hemorrhoids was 2.38 higher than that of the surgical group (p<0.01), and ORs increased to 1.99 and 1.61 in patients that received chemotherapy and patients with diabetes, respectively (p<0.01).
Pelvic RT increased anal bleeding and symptomatic hemorrhoids. In particular, chemotherapy and diabetes also increased the risk. If patients with hemorrhoids receive pelvic RT, attention is required to prevent hemorrhoid aggravation.
背景/目的：盆腔放疗（RT）往往忽略肛管毒性。然而，痔疮患者可能会因较低的辐射剂量而感到困扰。我们试图确定接受 RT 的宫颈癌患者的痔疮与肛门症状之间是否存在相关性。
分析了 2015 年至 2019 年接受宫颈癌根治性治疗的患者的保险索赔数据。治疗完成后 1 年内记录了出血、直肠炎和痔疮等不良事件。采用无条件泊松回归估计比值比（OR），并调整了年龄、治疗方法、化疗和合并症。
获得了 2015 年至 2019 年接受治疗的 67114 名有保险的宫颈癌患者的详细信息。其中，对至少有一年随访数据、以根治为目的治疗的 5919 名患者进行了分析。根治性放疗组（DRT 组）肛门出血的 OR 比单纯手术组（手术组）高 10.57（p<0.01）。新出现的痔疮在手术组（3.17%）、术后放疗组（5.38%）和 DRT 组（7.58%）中逐渐增加。DRT 组新发痔疮的 OR 比手术组高 2.38（p<0.01），在接受化疗和糖尿病的患者中，OR 分别增加至 1.99 和 1.61（p<0.01）。
盆腔 RT 增加了肛门出血和有症状的痔疮。特别是，化疗和糖尿病也增加了风险。如果患有痔疮的患者接受盆腔 RT，则需要注意防止痔疮恶化。
