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Case History

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Image not available. A 60-year-old man is admitted with diarrhoea. He has T3 N1 M0 rectal carcinoma and is receiving long-course chemoradiotherapy. Prior to the start of treatment the patient opened his bowels twice daily. The patient is now two weeks into his treatment and is opening his bowels six times daily. He is severely fatigued.

What are the acute side effects of pelvic radiotherapy?

How would you manage a patient with acute side effects from pelvic radiotherapy?

What are the late side effects of pelvic radiotherapy?

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Background

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Image not available. Pelvic radiotherapy is used in the treatment of many cancers including rectal carcinoma, prostate cancer and cervical tumours. Directing radiation at the pelvis results in a number of different side effects, which largely relate to normal tissue damage. Advances in radiotherapy have resulted in less normal tissue damage and, as a result, fewer treatment-related side-effects.1

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What are the acute side effects of pelvic radiotherapy?

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Bowel toxicity
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Bowel frequency and consistency can be affected by radiotherapy. Patients can also pass mucus or blood during treatment and often experience tenesmus.

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Intestinal permeability alters during radiotherapy as a result of gastrointestinal mucositis. The pathogenesis is thought to be the same as that of oral mucositis (see section on mucositis). Certain factors are known to increase the likelihood of bowel toxicity and should be noted prior to commencing treatment (Table 29.1).

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Table Graphic Jump Location
Table 29.1Risk factors for bowel toxicity after radiation therapy for prostate cancer. (Adapted from ref. 1.)
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Bladder toxicity
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Patients may experience 'cystitis-like' symptoms such as dysuria, increased frequency and urinary urgency. Male patients undergoing pelvic radiotherapy for prostate cancer frequently notice a reduced urinary flow.

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Skin toxicity
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The likelihood of skin toxicity depends upon the site of the radiotherapy target volume. Skin toxicity is uncommon in the treatment of prostate cancer and high rectal tumours. However, it can be severe in the treatment of low rectal, vulval tumours and tumours involving the anal margin.

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How would you manage a patient with side effects from pelvic radiotherapy?

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A change in bowel habit is an expected side-effect, but if any doubt exists as to the cause of diarrhoea then stool samples should be sent for culture and sensitivities. If there has been recent antibiotic treatment it is advisable to check for Clostridium difficile infection.

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Management of acute bowel toxicity is supportive and comprises adequate hydration and antidiarhoeal agents such as ...

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