만성 방사선 직장염의 임상적 고찰

Abstract

Background/Aims: The adverse effects of radiation on the bowel after radiotherapy of aMomino- pelvic malignancy have been well described, and its chronic late form is progressive and poor in prognosis. Because of the close proximity to the pelvic organ and relative immobility, the rectum is the most common site of late radiation injury. In this study, we report the characteristics of late radiaton induced proctitis. Methods: The 28 patients with newly developed hematochezia at least 6 months after radiotherapy due to cervical cancer were reviewed from November 1993 to November 1994. Predisposing factors and clinical characteristics were examined. Sigmoidoscopy and endoscopic biopsy were performed, and symptom score, degree of sigmoidoscopic findings, and pathologic score were examined. Results: The peak incidence of hematochezia occurred after a latent period of 9 months from irradiation, and the mean latent period was 11.5 2.4 months(3 72 months). Of the previousely known predisposing factors, obesity and previous operation were most frequent, but they are not associated with the severity of chronic radiation proctitis. However, in patients with more than two predisposing factors, the severer degree of sigmoidoscopic findings was noted, compared witb patients with no predisposing factor. Age and the stage of malignancy were not associated with severity of chronic radiation proctitis. The mean total external and internal radiation dose was 8289138 cGy(6,600 10,300 cGy), and the total rectal radiation dose was 7,213 223(4,794-9,252 cGy), but we found no association between radiation dose and severity of radiation proctitis. And no reliable correlation was found in symptom score, degree of sigmoidosco- pic findings, and pathologic score, except between symptom score and pathologic score. Treatment was done with sucralfate enema, systemic steroid and sucralfate enema, etc., and its results are being followed up. The operation(transverse loop colostomy, low anterior resection, transverse end colostomy) were performed in 3 cases due to rectovaginal fistula and intractable hematochezia, and relapse was developed in 1 case. Conclusions: Chronic radiation proctitis was the progressive disease with a )ong latent period as in other studies, and there was no association between radiation dose and severity of disease, but previousely known predisposing factors were involved in the severer disease state. In the grade system of the disease severity, reliable correlation was found only between symptom score and pathologic score, but not with sigmoidoscopic findings, so we think that a more reliable grade system and more investigation for treatment and prevention of this progressive disease are needed.