Revista de enfermedades y trastornos inflamatorios del intestino

Tolerability of Radiation Therapy in Patients with Inflammatory Bowel Disease

Abstract

Yu Suzuki, Haruo Matsushita, Rei Umezawa, Takaya Yamamoto, Yojirou Ishikawa, Noriyoshi Takahashi, Kazuya Takeda, Yu Katagiri, Shun Tasaka, Katsuya Fukui, Kosei Kawabata

Conventionally, radiation therapy (RT) in patients with inflammatory bowel disease (IBD) patients is considered to cause serious gastrointestinal (GI) tract. adverse events; thus, these patients are unable to receive the same RT as that administered to patients without IBD. However, it is unclear whether RT in IBD patients causes serious adverse events or poorly controlled IBD. The purpose of this study was to clarify the acute and late radiological GI toxicity in IBD patients.

Objective of the study:  To evaluate the tolerability of radiation therapy in patients with inflammatory bowel disease.

 Patients and methods: Data of IBD patients who received RT to the abdominal pelvis in our hospital between 1997 and 2017 were reviewed retrospectively. We excluded cases that were not irradiated to the GI tract. Radiation toxicity was examined according to the Common Terminology Criteria for Adverse Events, version 4.0 (CTCAE v4.0). Toxicity that occurred within 90 days from the last administration of RT was defined as acute toxicity, while toxicity occurring thereafter was defined as late toxicity.

Results: Our study included 17 patients; nine with ulcerative colitis (UC), seven with Crohn's disease (CD), and one unknown case. The median follow-up period after irradiation was 19 months. Median total dose of RT was 50 Gy (range; 3-145). Median dose per fraction was 2 Gy (range; 1.8-8). 16 patients received three-dimensional external beam radiotherapy (3D-EBRT) and 1 patient received low dose rate (low dose rate) brachytherapy. Regarding irradiation field, the whole pelvis was used in two cases, small pelvis in two cases, tumour bed or local region in nine cases, total body irradiation (TBI) in three cases, and whole brain and total spinal cord in one case. No Grade 3 or higher GI toxicities were observed in either the acute or late phases. IBD activity exacerbations were not clearly observed after RT.

Conclusion:  Our results indicated that RT of the abdomen or pelvis was tolerable in patients with IBD.