Surgery News - November 2008 - (Page 23)

NOVEMBER 2008 • SURGERY NEWS ONCOLOGY 23 Survey Reveals Unexpected Defecation After Radiation BY JANE SALODOF MACNEIL Else vier Global Medical Ne ws G Ö T E B O R G , S W E D E N — Unexpected defecation in clothing plagued 1 in 10 gynecologic cancer survivors who answered a detailed 351-question survey on late side effects of external radiotherapy at the Karolinska Institute in Stockholm. “We were actually quite shocked,” Dr. Helena C.J. Lind, a specialist in medical oncology and radiotherapy, said in an interview after reporting the unexpected survey result at the annual meeting of the European Society for Therapeutic Radiology and Oncology “I think this is so embarrassing for them, so they don’t speak out. ” she said, noting that the women had no physical sensations alerting them to these bowel movements before they occurred. Dr. Lind and her coinvestigators from the institute associated the troubling late effect with ionizing radiation doses of 40 Gy or more to the rectum and sigmoid colon. Survivors who received mean doses of 45 Gy or less to less than 30% of the rectal or sigmoid volume did not report this problem, she said. The investigators sent surveys to 677 gynecologic cancer survivors who were less than 80 years of age and had been treated out the late effect had external radiotherapy only, she said. Subgroup analysis by type of gynecologic cancer showed that women treated for uterine sarcoma had the greatest relative risk for unexpected defecation (relative risk, 3.17), whereas those treated for endometrial cancers were least likely to report the symptom (RR, 0.59). Radiation oncologists at the Karolinska Institute used a large field when treating uterine sarcoma during the time period covered in the study, Dr. Lind noted. Unexpected defecation occurred in about 8% of women who responded to the survey during the first 60 months after treatment, and peaked at around 13% of those queried during the period from 60 to 120 months. It then fell to about 9% for those with longer follow-up, but Dr. Lind said it was difficult to draw a conclusion about timing based on these data. Clinicians have to ask patients about this side effect, Dr. Lind said. “This report is very interesting and raises the issue of how thoroughly we ques- tion our patients for sequelae of therapy,” said Dr. William J. Hoskins, who commented on the study. How much of this is caused by irradiation and how much by the combination of irradiation and pelvic surgery isn’t clear, added Dr. Hoskins, an ACS Fellow who is executive director of surgical activities at Memorial Sloan-Kettering Cancer Center in New York. “This report should stimulate cooperative groups who study pelvic cancers to develop specific protocols to further investigate this issue,” he added. ■ THE TROUBLING LATE EFFECT IS ASSOCIATED WITH IONIZING RADIATION DOSES OF 40 GY OR MORE TO THE RECTUM AND SIGMOID COLON. with radiotherapy between 1991 and 2003. They also surveyed 480 women matched for age and geographical location in the Swedish Population Registry. Responses were received from 77% of the survivors and 72% of the control group, whose members never had pelvic radiotherapy. After excluding women who experienced recurrences or had poor command of the Swedish language, the investigators had a study population of 498 survivors with a mean follow-up of 7.8 years. Medical records were available for all but one of these survivors, and 85% had on file dose-volume histograms for the anal sphincter, rectum, sigmoid, small intestine, urinary bladder, vagina, and pelvic bones. All told, 52 survivors (10.4%) reported they defecated in their clothing without warning at least once every 6 months. Among 344 controls, 3 women (0.9%) had the same complaint. Compared with the controls, survivors had a relative risk of 10. Comparing symptomatic survivors with survivors who did not complain of sudden defecation, the investigators found the side effect was more common among older women (mean age 66 years vs. 63.9 years), but Dr. Lind said the difference was not significant. Unexpected defecation also occurred more among those treated with external radiotherapy alone: 17.3% of symptomatic survivors vs. 7.8% of survivors with- The test isn’t real. The security is. Find real conﬁdence in 5mm clip security with LIGAMAX™ 5. The LIGAMAX™ 5 clip applier delivers the same secure Medium/Large clips you get from a 10mm applier, but in a slimmer, more versatile 5mm size. For more information, visit www.LIGAMAX5.com, or call for a demo at 1-800-USE-ENDO. © 2008 Ethicon Endo-Surgery DSL#08-0366.H http://www.LIGAMAX5.com http://www.LIGAMAX5.com

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Surgery News - November 2008

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