Severe Rectal Injury Following Radiation for Prostatic Cancer

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Abstract
Between 1970-1981, 348 patients underwent definitive irradiation. Of these patients, 6 (1.7%) sustained severe rectal injury as manifest by major rectal bleeding, rectal stricture, rectal mucosal slough and rectal ulceration. Severe rectal injury was observed in 0 of 13 patients (0%) treated with 125I, 3 of 329 (1%) treated with 6400 to 6800 rad external irradiation, 2 of 39 (5%) treated with 7000 to 7300 rad external irradiation, and 1 of 7 (14%) treated with 198Au and external irradiation. The impact of radiation dose, radiation therapy technique and surgical trauma was assessed. Rectal injury was managed by supportive measures in 2 patients and by diverting colostomy in 3 with benefit. One patient underwent abdominoperineal resection. A small bowel fistula and an intraabdominal abscess developed, and the patient died.