Cancer Res Treat.  2016 Jan;48(1):297-303. 10.4143/crt.2014.333.

Can Anorectal Manometry Findings Predict Subsequent Late Gastrointestinal Radiation Toxicity in Prostate Cancer Patients?

• Choi Y
• Park W
• Rhee PL

• KMID: 2152288
• DOI: http://doi.org/10.4143/crt.2014.333

Abstract

PURPOSE
The purpose of this study is to investigate the influence of radiotherapy (RT) on anorectal function and radiation-induced toxicity in patients with prostate cancer.
MATERIALS AND METHODS
Fifty-four patients who were treated with RT for prostate cancer (T1c-4N0-1M0) were evaluated. To assess the changes in anorectal function, two consecutive anorectal manometry readings were performed in patients, before and after 4-6 months of RT. Late gastrointestinal (GI) toxicity was defined as symptoms occurring more than 6 months after RT. The median radiation dose was 70.0 Gy (range, 66.0 to 74.0 Gy). Whole pelvis field RT was performed in 16 patients (29.6%). Grade of late radiation toxicity was defined in accordance to the severity of symptoms (Gulliford's scoring system).
RESULTS
The median follow-up period was 60 months. Resting anal pressure (p=0.001), squeeze pressure (p < 0.001), and urge to defecate volume (p=0.025) were significantly reduced after RT. Fourteen patients (25.9%) experienced late GI toxicities. Among them, nine (16.7%) showed severe (grade > or = 2) late toxicities. Elevated resting and squeeze external anal sphincter pressure prior to RT and large urge to defecate volumes after RT were associated with the occurrence of late GI toxicities.
CONCLUSION
RT caused symptomatic anorectal dysfunction and resulted in a weakened anal sphincter. Increased urge to defecate volumes after RT were related to late GI toxicities. Elevated resting and squeeze anal sphincter pressure prior to RT rodcan be used to identify patients with an increased risk of late GI toxicities.ConclusionRT caused symptomatic anorectal dysfunction. An increased anal pressure prior to RT and urge to defecate volume after RT was related to an occurrence of late GI toxicities. Application of ARM for screening patients who have an elevated ASP prior to RT could be helpful in identifying patients with an increased risk of late GI toxicities.

Keyword

Prostatic neoplasms; Radiation toxicity; Anorectal manometry

MeSH Terms

Anal Canal
Arm
Follow-Up Studies
Humans
Manometry*
Mass Screening
Pelvis
Prostate*
Prostatic Neoplasms*
Radiotherapy
Reading
Viperidae

Reference

References

1. Yeoh EK, Holloway RH, Fraser RJ, Botten R, Di Matteo A, Moore JW, et al. Anorectal function after three- versus two-dimensional radiation therapy for carcinoma of the prostate. Int J Radiat Oncol Biol Phys. 2009; 73:46–52.

2. Smeenk RJ, Hopman WP, Hoffmann AL, van Lin EN, Kaanders JH. Differences in radiation dosimetry and anorectal function testing imply that anorectal symptoms may arise from different anatomic substrates. Int J Radiat Oncol Biol Phys. 2012; 82:145–52.

3. Mantini G, Tagliaferri L, Mattiucci GC, Balducci M, Frascino V, Dinapoli N, et al. Effect of whole pelvic radiotherapy for patients with locally advanced prostate cancer treated with radiotherapy and long-term androgen deprivation therapy. Int J Radiat Oncol Biol Phys. 2011; 81:e721–6.

4. Yeoh EK, Bartholomeusz DL, Holloway RH, Fraser RJ, Botten R, Di Matteo A, et al. Disturbed colonic motility contributes to anorectal symptoms and dysfunction after radiotherapy for carcinoma of the prostate. Int J Radiat Oncol Biol Phys. 2010; 78:773–80.

5. Yeoh EK, Holloway RH, Fraser RJ, Botten RJ, Di Matteo AC, Butters J. Pathophysiology and natural history of anorectal sequelae following radiation therapy for carcinoma of the prostate. Int J Radiat Oncol Biol Phys. 2012; 84:e593–9.

6. Maeda Y, Hoyer M, Lundby L, Norton C. Faecal incontinence following radiotherapy for prostate cancer: a systematic review. Radiother Oncol. 2011; 98:145–53.

7. Krol R, Hopman WP, Smeenk RJ, Van Lin EN. Increased rectal wall stiffness after prostate radiotherapy: relation with fecal urgency. Neurogastroenterol Motil. 2012; 24:339–e166.

8. Michalski JM, Gay H, Jackson A, Tucker SL, Deasy JO. Radiation dose-volume effects in radiation-induced rectal injury. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl):S123–9.

9. Berndtsson I, Lennernas B, Hulten L. Anorectal function after modern conformal radiation therapy for prostate cancer: a pilot study. Tech Coloproctol. 2002; 6:101–4.

10. Kim GE, Lim JJ, Park W, Park HC, Chung EJ, Seong J, et al. Sensory and motor dysfunction assessed by anorectal manometry in uterine cervical carcinoma patients with radiation-induced late rectal complication. Int J Radiat Oncol Biol Phys. 1998; 41:835–41.

11. Bartlett L, Nowak M, Ho YH. Impact of fecal incontinence on quality of life. World J Gastroenterol. 2009; 15:3276–82.

12. Kim JH. How to interpret conventional anorectal manometry. J Neurogastroenterol Motil. 2010; 16:437–9.

13. Gulliford SL, Foo K, Morgan RC, Aird EG, Bidmead AM, Critchley H, et al. Dose-volume constraints to reduce rectal side effects from prostate radiotherapy: evidence from MRC RT01 Trial ISRCTN 47772397. Int J Radiat Oncol Biol Phys. 2010; 76:747–54.

14. Andreyev J. Gastrointestinal complications of pelvic radiotherapy: are they of any importance? Gut. 2005; 54:1051–4.

15. Lundby L, Krogh K, Jensen VJ, Gandrup P, Qvist N, Overgaard J, et al. Long-term anorectal dysfunction after postoperative radiotherapy for rectal cancer. Dis Colon Rectum. 2005; 48:1343–9.

16. Krol R, Smeenk RJ, van Lin EN, Hopman WP. Impact of late anorectal dysfunction on quality of life after pelvic radiotherapy. Int J Colorectal Dis. 2013; 28:519–26.

17. Pinkawa M. Spacer application for prostate cancer radiation therapy. Future Oncol. 2014; 10:851–64.

18. Longobardi B, Berardi G, Fiorino C, Alongi F, Cozzarini C, Deli A, et al. Anatomical and clinical predictors of acute bowel toxicity in whole pelvis irradiation for prostate cancer with Tomotherapy. Radiother Oncol. 2011; 101:460–4.

19. van Lin EN, Kristinsson J, Philippens ME, de Jong DJ, van der Vight LP, Kaanders JH, et al. Reduced late rectal mucosal changes after prostate three-dimensional conformal radiotherapy with endorectal balloon as observed in repeated endoscopy. Int J Radiat Oncol Biol Phys. 2007; 67:799–811.

20. Bacon CG, Giovannucci E, Testa M, Glass TA, Kawachi I. The association of treatment-related symptoms with quality-of-life outcomes for localized prostate carcinoma patients. Cancer. 2002; 94:862–71.