Principles of treatment of late rectal radiation damage in cancer patients

Abstract

Malignant neoplasms of the pelvic organs in the structure of cancer incidence make up about 30 % of the adult population of our country. The widespread use of radiation therapy, unfortunately, has also increased the frequency of radiation damage to the pelvic organs, which, as a rule, take a chronic course. Late radiation damage to the pelvic organs is a fairly common complication of radiation therapy for prostate cancer. According to various authors, the frequency of such iatrogenic pathological changes is up to 25 %. In fact, some patients who are cured of a malignant neoplasm acquire a new disease that significantly reduces the quality of life and requires treatment. During radiation therapy of prostate cancer, various anatomical formations can fall into the zone of radiation fields: the bladder, rectum, intra-pelvic tissue, neurovascular bundles and pelvic bones. It should be noted that isolated lesions of one organ are rare and in most cases they are combined. A special place in clinical practice is occupied by cases of local radiation injuries of the rectum, including severe complications of radiation and combined treatment associated with the formation of fistulas against the background of radiation-induced  intra-pelvic fibrosis in the absence of a relapse of the underlying disease. In addition, this situation is associated with a violation of the psycho-emotional status of patients, a sharp decrease in the quality of life, difficulties in social adaptation in society and family, pain syndrome, and problems of medical rehabilitation. Unfortunately, conservative measures for such local radiation injuries are not always effective, and the results of surgical interventions are far from ambiguous and require careful study of patients, search for an algorithm of indications and acceptable standardization of surgical manipulations.  This paper presents the basic principles of diagnosis, comprehensive treatment and rehabilitation of patients with late radiation rectitis, depending on the severity of the pathological process. Given the growth of malignant neoplasms  of the pelvic organs, we can assume a relative increase in the number of patients with complications associated with radiation therapy, which require rehabilitation measures. Such patients come to the attention of oncologists, radiologists, coloproctologists, gastroenterologists and therapists, etc. Currently, our country lacks a network of specialized regional departments that deal with this problem, as well as treatment standards, clinical recommendations, and  an algorithm for diagnostic and rehabilitation measures for local radiation injuries. In connection with the above, it became necessary to summarize the data of clinical studies based on their own experience.