Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-10T10:41:22.517Z Has data issue: false hasContentIssue false
  • English
  • Français

Should inflammatory bowel disease be a contraindication to radiation therapy: a systematic review of acute and late toxicities

Published online by Cambridge University Press:  22 September 2020

J. Nathan Cantrell ,
Gabriel S. Vidal ,
Hussein Bitar ,
Salahuddin Ahmad Open the ORCID record for Salahuddin Ahmad [Opens in a new window]  and
Tyler C. Gunter
J. Nathan Cantrell
Affiliation:
Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
Gabriel S. Vidal
Affiliation:
Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
Hussein Bitar
Affiliation:
Department of Gastroenterology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
Salahuddin Ahmad*
Affiliation:
Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
Tyler C. Gunter
Affiliation:
Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
*
Author for correspondence: Salahuddin Ahmad, Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. E-mail: salahuddin-ahmad@ouhsc.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Inflammatory bowel disease (IBD) [i.e., Crohn’s disease (CD) and ulcerative colitis (UC)] has been considered a relative contraindication for radiation therapy (RT) to the abdomen or pelvis, potentially preventing patients with a diagnosis of IBD from receiving definitive therapy for their malignancy.

Method:

Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) conventions, a PubMed/MEDLINE literature search was conducted using the keywords RT, brachytherapy, inflammatory bowel disease, Crohn’s disease, ulcerative colitis and toxicity.

Results:

A total of 1,206 publications were screened with an addition of 8 studies identified through hand searching. Nineteen studies met the inclusion criteria for quantitative analysis. The total population across all studies was 497 patients, 50·5% having UC, 37% having CD and an additional 12·5% having unspecified IBD. Primary gastrointestinal malignancy (55%) followed by prostate cancer (40%) composed the bulk of the population. Acute and late grade 3 or greater gastrointestinal specific toxicity ranged from 0–23% to 0–13% respectively for those patients with IBD treated with RT to the abdomen or pelvis. In the literature reviewed, RT does not appear to increase fistula or stricture formation or IBD flares; however, one study did note RT to be a statistically significant risk factor for subsequent IBD flare on multivariate analysis.

Conclusions:

A review of reported acute and late toxicities suggests that patients with IBD should still be considered for definitive radiotherapy. Patient characteristics including IBD distribution relative to the irradiated field, inflammatory activity at the time of radiation, overall disease severity and disease phenotype in the case of CD (fistulising versus stricturing versus inflammatory only) should be considered on an individual basis when evaluating potential patients. When possible, advanced techniques with strict organ at risk dose constraints should be employed to limit toxicity in this patient population.

Keywords

Crohn’s diseaseinflammatory bowel diseaseradiation side-effectsradiation therapyradiation toxicityulcerative colitis
Type
Literature Review
Information
Journal of Radiotherapy in Practice , Volume 20 , Issue 4 , December 2021 , pp. 480 - 489
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ananthakrishnan, A N, Epidemiology and risk factors for IBD. Nat Rev Gastroenterol Hepatol 2015; 12 (4): 205–217.CrossRefGoogle ScholarPubMed
Barnett, G C, De Meerleer, G, Gulliford, S L, et al. The impact of clinical factors on the development of late radiation toxicity: results from the Medical Research Council RT01 trial (ISRCTN47772397). Clin Oncol (R Coll Radiol) 2011; 23 (9): 613–624.CrossRefGoogle Scholar
Murphy, C T, Ruth, K J, Buyyounouski, M K, et al. Evaluating toxicity from definitive radiation therapy for prostate cancer in men with inflammatory bowel disease: Patient selection and dosimetric parameters with modern treatment techniques. Pract Radiat Oncol 2015; 5 (3): e215–e222.CrossRefGoogle ScholarPubMed
Gestaut, M M and Swanson, G P, Long term clinical toxicity of radiation therapy in prostate cancer patients with Inflammatory Bowel Disease. Rep Pract Oncol Radiother 2017; 22 (1): 77–82.CrossRefGoogle ScholarPubMed
Grann, A and Wallner, K, Prostate brachytherapy in patients with inflammatory bowel disease. Int J Radiat Oncol Biol Phys 1998; 40 (1): 135–138.CrossRefGoogle ScholarPubMed
Peters, C A, Cesaretti, J A, Stone, N N, et al. Low-dose rate prostate brachytherapy is well tolerated in patients with a history of inflammatory bowel disease. Int J Radiat Oncol Biol Phys 2006; 66 (2): 424–429.CrossRefGoogle ScholarPubMed
Pai, H H, Keyes, M, Morris, W J, et al. Toxicity after (125)I prostate brachytherapy in patients with inflammatory bowel disease. Brachytherapy 2013; 12 (2): 126–133.CrossRefGoogle ScholarPubMed
Mohammed, W, Hoskin, P, Henry, A, et al. Short-term Toxicity of High Dose Rate Brachytherapy in Prostate Cancer Patients with Inflammatory Bowel Disease. Clin Oncol (R Coll Radiol) 2018; 30 (9): 534–538.CrossRefGoogle ScholarPubMed
Green, S, Stock, R G, Greenstein, A J, Rectal cancer and inflammatory bowel disease: natural history and implications for radiation therapy. Int J Radiat Oncol Biol Phys 1999; 44 (4): 835–40.CrossRefGoogle ScholarPubMed
Chang, B W, Kumar, A M S, Koyfman, S, et al. Radiation therapy in patients with inflammatory bowel disease and colorectal cancer: risks and benefits. Int J Colorectal Dis 2015; 30 (3): 403–408.CrossRefGoogle ScholarPubMed
Mudgway, R, Bryant, A K, Heide, E S, et al. A Matched Case-Control Analysis of Clinical Outcomes for Inflammatory Bowel Disease Patients with Rectal Cancer Treated with Pelvic Radiation Therapy. Int J Radiat Oncol Biol Phys 2019; 105 (5): 994–1004.CrossRefGoogle ScholarPubMed
Bosch, S L, van Rooijen, S J, Bokkerink, G M J, et al. Acute toxicity and surgical complications after preoperative (chemo)radiation therapy for rectal cancer in patients with inflammatory bowel disease. Radiother Oncol 2017; 123 (1): 147–153.CrossRefGoogle ScholarPubMed
Willett, C G, Ooi, C-J, Zietman, A L, et al. Acute and late toxicity of patients with inflammatory bowel disease undergoing irradiation for abdominal and pelvic neoplasms. Int J Radiat Oncol Biol Phys 2000; 46(4): 995–998.CrossRefGoogle ScholarPubMed
Rhome, R M, Axelrad, J, Itzkowitz, S, et al. Acute and Chronic Complications After Abdominal/Pelvic Radiation in Patients With Inflammatory Bowel Disease. Int J Radiat Oncol Biol Phys 2015; 93 (3): E492.CrossRefGoogle Scholar
Annede, P, Seisen, T, Klotz, C, et al. Inflammatory bowel diseases activity in patients undergoing pelvic radiation therapy. J Gastrointest Oncol 2017; 8 (1): 173–179.CrossRefGoogle ScholarPubMed
Kirk, P S, Govani, S, Borza, T, et al. Implications of Prostate Cancer Treatment in Men With Inflammatory Bowel Disease. Urology 2017; 104: 131–136.CrossRefGoogle ScholarPubMed
Glick, D, Warde, P, Su, J, et al. Gastrointestinal toxicity in patients with inflammatory bowel disease treated with pelvic radiation therapy. Int J Radiat Oncol Biol Phys 2014; 90 (1): S388–S389.CrossRefGoogle Scholar
Feagins, L A, Kim, J, Chandrakumaran, A, et al. Rates of Adverse IBD-Related Outcomes for Patients With IBD and Concomitant Prostate Cancer Treated With Radiation Therapy. Inflamm Bowel Dis 2020; 26(5):728–733.CrossRefGoogle ScholarPubMed
Lin, D, Lehrer, E J, Rosenberg, J, et al. Toxicity after radiotherapy in patients with historically accepted contraindications to treatment (CONTRAD): An international systematic review and meta-analysis. Radiother Oncol 2019; 135: 147–152.CrossRefGoogle ScholarPubMed
Song, D Y, Lawrie, W T, Abrams, R A, et al. Acute and late radiotherapy toxicity in patients with inflammatory bowel disease. Int J Radiat Oncol Biol Phys 2001; 51 (2): 455–459.CrossRefGoogle ScholarPubMed
White, E C, Murphy, J D, Chang, D T, et al. Low Toxicity in Inflammatory Bowel Disease Patients Treated With Abdominal and Pelvic Radiation Therapy. Am J Clin Oncol 2015. 38 (6): 564–569.CrossRefGoogle ScholarPubMed
Lee, W R, Dignam, J J, Amin, M B, et al. Randomized Phase III Noninferiority Study Comparing Two Radiotherapy Fractionation Schedules in Patients With Low-Risk Prostate Cancer. J Clin Oncol 2016; 34 (20): 2325–2332.CrossRefGoogle ScholarPubMed
Gunderson, L L, Winter, K A, Ajani, J A, et al. Long-term update of US GI intergroup RTOG 98-11 phase III trial for anal carcinoma: survival, relapse, and colostomy failure with concurrent chemoradiation involving fluorouracil/mitomycin versus fluorouracil/cisplatin. J Clin Oncol 2012; 30 (35): 4344–4351.CrossRefGoogle ScholarPubMed
Kachnic, L A, Winter, K, Myerson, R J, et al. RTOG 0529: a phase 2 evaluation of dose-painted intensity modulated radiation therapy in combination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal. Int J Radiat Oncol Biol Phys 2013; 86 (1): 27–33.CrossRefGoogle ScholarPubMed