Lischalk Jonathan W, Santos Vianca F, Vizcaino Brianna, Sanchez Astrid, Mendez Christopher, Maloney-Lutz Kathleen, Serouya Sam, Blacksburg Seth R, Carpenter Todd, Tam Moses, Niglio Scott, Huang William, Taneja Samir, Zelefsky Michael J, Haas Jonathan A
Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Health - Long Island, New York, New York.
Department of Radiation Medicine, Lombardi Cancer Center at Georgetown University Hospital, Washington, DC.
Adv Radiat Oncol. 2025 Feb 22;10(5):101747. doi: 10.1016/j.adro.2025.101747. eCollection 2025 May.
Screening colonoscopies (CS) performed before prostate stereotactic body radiation therapy (SBRT) allow for identifying synchronous malignancies and comorbid gastrointestinal (GI) conditions. Performing these procedures prior to radiation precludes the necessity of post-SBRT pelvic instrumentation, which may lead to severe toxicity and fistulization. We review compliance of CSs, incidence of GI pathology, and the impact of pretreatment CS findings on subsequent physician-reported toxicity and patient-reported quality of life (QoL).
We reviewed an institutional database of patients treated for prostate cancer with SBRT including toxicity and QoL outcomes. A detailed review of pretreatment CS findings was reviewed including identification of diverticulosis, location of polyp resection, and presence of hemorrhoids. Pretreatment CS findings were then correlated with outcomes following SBRT.
Identification of comorbid GI conditions was a common event, with the presence of diverticulosis in 49.5% (n = 100), hemorrhoids in 67% (n = 136), and polyps in 48% (n = 98). More than half of patients with polyps removed had at least 1 removed from the rectosigmoid. Pretreatment CS did not introduce a delay in SBRT start date. Grade 1 toxicity was significantly lower in patients who underwent CS closer to the initiation of SBRT. There was no increased risk of physician-graded toxicity in the presence of diverticulosis, hemorrhoids, or polyps. Patient-reported GI QoL pattern in our screening cohort mimicked that seen in the previously published nonscreened population. There was no overt QoL detriment observed in patients who had GI pathology identified before SBRT.
GI pathology identified in our elderly patient population was commonly identified on pretreatment CS. Screening CS may optimize bowel health for patients heading into radiation therapy. Toxicity and QoL for patients with GI pathologies identified on pretreatment CS do not preclude the delivery of prostate SBRT. We advocate for pretreatment CS in patients eligible prior to SBRT.
在前列腺立体定向体部放疗（SBRT）前进行的筛查性结肠镜检查（CS）有助于识别同步性恶性肿瘤和合并的胃肠道（GI）疾病。在放疗前进行这些检查可避免SBRT后盆腔器械操作的必要性，而这可能导致严重毒性反应和瘘管形成。我们回顾了CS的依从性、GI病理学的发生率以及预处理CS结果对随后医生报告的毒性反应和患者报告的生活质量（QoL）的影响。
我们回顾了一个接受前列腺癌SBRT治疗患者的机构数据库，包括毒性反应和QoL结果。对预处理CS结果进行了详细回顾，包括憩室病的识别、息肉切除部位以及痔疮的存在情况。然后将预处理CS结果与SBRT后的结果进行关联。
合并GI疾病的识别是常见情况，其中憩室病的发生率为49.5%（n = 100），痔疮为67%（n = 136），息肉为48%（n = 98）。息肉切除患者中超过一半至少有1个息肉从直肠乙状结肠切除。预处理CS未导致SBRT开始日期延迟。在更接近SBRT开始时进行CS的患者中，1级毒性反应显著更低。存在憩室病、痔疮或息肉时，医生分级的毒性反应风险没有增加。我们筛查队列中患者报告的GI QoL模式与先前发表的未筛查人群相似。在SBRT前识别出GI疾病的患者中未观察到明显的QoL损害。
在我们的老年患者人群中，预处理CS通常能识别出GI病理学情况。筛查性CS可能会优化接受放疗患者的肠道健康。预处理CS中识别出GI疾病的患者的毒性反应和QoL并不妨碍进行前列腺SBRT。我们主张在符合条件的患者中于SBRT前进行预处理CS。
