Rectal Cancer and Radiation in Colitis

Patricio B. Lynn; Catherine Cronin; Sriram Rangarajan; Maria Widmar

doi:10.1055/s-0043-1762561

Clinics in Colon and Rectal Surgery, Table of Contents

Clin Colon Rectal Surg 2024; 37(01): 030-036
DOI: 10.1055/s-0043-1762561

Review Article

Rectal Cancer and Radiation in Colitis

Authors

Patricio B. Lynn

¹Division of Colorectal Surgery, Department of General Surgery, New York Presbyterian – Weill-Cornell, New York, New York
Catherine Cronin

²Colorectal Surgery Service, Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
Sriram Rangarajan

²Colorectal Surgery Service, Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
Maria Widmar

²Colorectal Surgery Service, Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York

Abstract

Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer. When IBD patients develop a rectal cancer, this should be treated with the same oncological principles and guidelines as the general population. Rectal cancer treatment includes surgery, chemotherapy, and radiation therapy (RT). Many IBD patients will require a total proctocolectomy with an ileal-pouch anal anastomosis (IPAA) and others, restoration of intestinal continuity may not be feasible or advisable. The literature is scarce regarding outcomes of IPAA after RT. In the present review, we will summarize the evidence regarding RT toxicity in IBD patients and review surgical strategies and outcomes of IPAA after RT.

Keywords

inflammatory bowel disease - rectal cancer - ileal pouch-anal anastomosis - radiation therapy - functional outcomes

Full Text

References

References
1 Jess T, Simonsen J, Jørgensen KT, Pedersen BV, Nielsen NM, Frisch M. Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years. Gastroenterology 2012; 143 (02) 375-81.e1 , quiz e13–e14
2 Keller DS, Windsor A, Cohen R, Chand M. Colorectal cancer in inflammatory bowel disease: review of the evidence. Tech Coloproctol 2019; 23 (01) 3-13
3 Beaugerie L, Itzkowitz SH. Cancers complicating inflammatory bowel disease. N Engl J Med 2015; 372 (15) 1441-1452
4 Peixoto RD, Ferreira AR, Cleary JM, Fogacci JP, Vasconcelos JP, Jácome AA. Risk of cancer in inflammatory bowel disease and pitfalls in oncologic therapy. Nature 1993; 362 (6423): 847-849
5 Lowe SW, Schmitt EM, Smith SW, Osborne BA, Jacks T. p53 is required for radiation-induced apoptosis in mouse thymocytes. Nature 1993; 362 (6423): 847-849
6 Theis VS, Sripadam R, Ramani V, Lal S. Chronic radiation enteritis. Clin Oncol (R Coll Radiol) 2010; 22 (01) 70-83
7 Hasleton PS, Carr N, Schofield PF. Vascular changes in radiation bowel disease. Histopathology 1985; 9 (05) 517-534
8 Yeoh E, Horowitz M, Russo A. et al. Effect of pelvic irradiation on gastrointestinal function: a prospective longitudinal study. Am J Med 1993; 95 (04) 397-406
9 Husebye E, Hauer-Jensen M, Kjørstad K, Skar V. Severe late radiation enteropathy is characterized by impaired motility of proximal small intestine. Dig Dis Sci 1994; 39 (11) 2341-2349
10 Ananthakrishnan AN. Epidemiology and risk factors for IBD. Nat Rev Gastroenterol Hepatol 2015; 12 (04) 205-217
11 Bosch SL, van Rooijen SJ, Bökkerink GM. 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 (01) 147-153
12 White EC, Murphy JD, Chang DT, Koong AC. Low toxicity in inflammatory bowel disease patients treated with abdominal and pelvic radiation therapy. Am J Clin Oncol 2015; 38 (06) 564-569
13 Mudgway R, Bryant AK, Heide ES. et al. A matched case-control analysis of clinical outcomes for patients with inflammatory bowel disease and rectal cancer treated with pelvic radiation therapy. Int J Radiat Oncol Biol Phys 2019; 105 (05) 994-1004
14 Lin D, Lehrer EJ, Rosenberg J, Trifiletti DM, Zaorsky NG. 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
15 Cantrell JN, Vidal GS, Bitar H, Ahmad S, Gunter TC. Should inflammatory bowel disease be a contraindication to radiation therapy: a systematic review of acute and late toxicities. J Radiother Pract 2021; 20 (04) 480-489
16 Lee WR, Dignam JJ, Amin MB. 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
17 Gunderson LL, Winter KA, Ajani JA. 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
18 Lynn PB, Van der Valk MJM, Claassen YHM, Shi Q, Widmar M, Bastiaannet E, Van de Velde CJH, Garcia-Aguilar J. Chemoradiation and Local Excision Versus Total Mesorectal Excision for T2N0 Rectal Cancer: Comparison of Short- and Long-Term Outcomes From 2 Prospective Studies. Ann Surg 2023; Jan 1; 277 (01) e96-e102
19 Murphy CT, Heller S, Ruth 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 (03) e215-e222
20 Kirk PS, Govani S, Borza T. et al. Implications of prostate cancer treatment in men with inflammatory bowel disease. Urology 2017; 104: 131-136
21 Feagins LA, 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 (05) 728-733
22 Annede P, Seisen T, Klotz C. et al. Inflammatory bowel diseases activity in patients undergoing pelvic radiation therapy. J Gastrointest Oncol 2017; 8 (01) 173-179
23 Larsen M, Mose H, Gislum M. et al. Survival after colorectal cancer in patients with Crohn's disease: a nationwide population-based Danish follow-up study. Am J Gastroenterol 2007; 102 (01) 163-167
24 Ouaïssi M, Maggiori L, Alves A. et al. Colorectal cancer complicating inflammatory bowel disease: a comparative study of Crohn's disease vs ulcerative colitis in 34 patients. Colorectal Dis 2011; 13 (06) 684-688
25 Ou B, Zhao J, Guan S, Lu A. Survival of colorectal cancer in patients with or without inflammatory bowel disease: a meta-analysis. Dig Dis Sci 2016; 61 (03) 881-889
26 Bansal P, Sonnenberg A. Risk factors of colorectal cancer in inflammatory bowel disease. Am J Gastroenterol 1996; 91 (01) 44-48
27 Jewel Samadder N, Valentine JF, Guthery S. et al. Colorectal cancer in inflammatory bowel diseases: a population-based study in Utah. Dig Dis Sci 2017; 62 (08) 2126-2132
28 Peyrin-Biroulet L, Lepage C, Jooste V, Guéant JL, Faivre J, Bouvier AM. Colorectal cancer in inflammatory bowel diseases: a population-based study (1976-2008). Inflamm Bowel Dis 2012; 18 (12) 2247-2251
29 Jensen AB, Larsen M, Gislum M. et al. Survival after colorectal cancer in patients with ulcerative colitis: a nationwide population-based Danish study. Am J Gastroenterol 2006; 101 (06) 1283-1287
30 Remzi FH, Preen M. Rectal cancer and ulcerative colitis: does it change the therapeutic approach?. Colorectal Dis 2003; 5 (05) 483-485
31 Merchea A, Wolff BG, Dozois EJ, Abdelsattar ZM, Harmsen WS, Larson DW. Clinical features and oncologic outcomes in patients with rectal cancer and ulcerative colitis: a single-institution experience. Dis Colon Rectum 2012; 55 (08) 881-885
32 Gorfine SR, Harris MT, Bub DS, Bauer JJ. Restorative proctocolectomy for ulcerative colitis complicated by colorectal cancer. Dis Colon Rectum 2004; 47 (08) 1377-1385
33 Alsughayer A, Grass F, McKenna NP, Petersen M, Mathis KL, Lightner AL. Does IBD portend worse outcomes in patients with rectal cancer? A case-matched analysis. Dis Colon Rectum 2020; 63 (09) 1265-1275
34 Maser EA, Sachar DB, Kruse D, Harpaz N, Ullman T, Bauer JJ. High rates of metachronous colon cancer or dysplasia after segmental resection or subtotal colectomy in Crohn's colitis. Inflamm Bowel Dis 2013; 19 (09) 1827-1832
35 Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol 2019; 114 (03) 384-413
36 NCCN. Colon cancer (version 2.2022). Accessed November 16, 2022 at: https://www.nccn.org/professionals/physician_gls/pdf/colon_blocks.pdf
37 Vogel JD, Felder SI, Bhama AR. et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of colon cancer. Dis Colon Rectum 2022; 65 (02) 148-177
38 Khan N, Cole E, Shah Y, Paulson EC. Segmental resection is a safe oncological alternative to total proctocolectomy in elderly patients with ulcerative colitis and malignancy. Colorectal Dis 2017; 19 (12) 1108-1116
39 Krugliak Cleveland N, Ollech JE, Colman RJ. et al. Efficacy and follow-up of segmental or subtotal colectomy in patients with colitis-associated neoplasia. Clin Gastroenterol Hepatol 2019; 17 (01) 205-206
40 Bogach J, Pond G, Eskicioglu C, Simunovic M, Seow H. Extent of surgical resection in inflammatory bowel disease associated colorectal cancer: a population-based study. J Gastrointest Surg 2021; 25 (10) 2610-2618
41 Øresland T, Bemelman WA, Sampietro GM. et al; European Crohn's and Colitis Organisation (ECCO). European evidence based consensus on surgery for ulcerative colitis. J Crohn's Colitis 2015; 9 (01) 4-25
42 Wu XR, Kiran RP, Remzi FH, Katz S, Mukewar S, Shen B. Preoperative pelvic radiation increases the risk for ileal pouch failure in patients with colitis-associated colorectal cancer. J Crohn's Colitis 2013; 7 (10) e419-e426
43 Ordás I, Eckmann L, Talamini M, Baumgart DC, Sandborn WJ. Ulcerative colitis. Lancet 2012; 380 (9853): 1606-1619
44 McLaughlin SD, Clark SK, Tekkis PP, Ciclitira PJ, Nicholls RJ. Review article: restorative proctocolectomy, indications, management of complications and follow-up–a guide for gastroenterologists. Aliment Pharmacol Ther 2008; 27 (10) 895-909
45 Burns EM, Bottle A, Aylin P. et al. Volume analysis of outcome following restorative proctocolectomy. Br J Surg 2011; 98 (03) 408-417
46 de Zeeuw S, Ahmed Ali U, Donders RART, Hueting WE, Keus F, van Laarhoven CJHM. Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies. Int J Colorectal Dis 2012; 27 (07) 843-853
47 Worley GHT, Fearnhead NS, Brown SR, Acheson AG, Lee MJ, Faiz OD. Association of Coloproctology of Great Britain and Ireland (ACPGBI) Inflammatory Bowel Disease Clinical Advisory Group, commentators in the 2017 ACPGBI Ileoanal Pouch Report, and Ileoanal Pouch Registry contributors. Review of current practice and outcomes following ileoanal pouch surgery: lessons learned from the Ileoanal Pouch Registry and the 2017 Ileoanal Pouch Report. Colorectal Dis 2018; 20 (10) 913-922
48 Lovegrove RE, Constantinides VA, Heriot AG. et al. A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients. Ann Surg 2006; 244 (01) 18-26
49 Um JW, M'Koma AE. Pouch-related dysplasia and adenocarcinoma following restorative proctocolectomy for ulcerative colitis. Tech Coloproctol 2011; 15 (01) 7-16
50 Bemelman WA, Warusavitarne J, Sampietro GM. et al. ECCO-ESCP consensus on surgery for Crohn's disease. J Crohn's Colitis 2018; 12 (01) 1-16
51 NCCN. Rectal cancer (Version 3.2022). Accessed November 16, 2022 at: https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf
52 Taylor FG, Quirke P, Heald RJ. et al; Magnetic Resonance Imaging in Rectal Cancer European Equivalence Study Study Group. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study. J Clin Oncol 2014; 32 (01) 34-43
53 Glynne-Jones R, Wyrwicz L, Tiret E. et al; ESMO Guidelines Committee. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28 (Suppl. 04) iv22-iv40
54 Kreis ME, Ruppert R, Kube R. et al; OCUM group. MRI-based use of neoadjuvant chemoradiotherapy in rectal carcinoma: surgical quality and histopathological outcome of the OCUM trial. Ann Surg Oncol 2020; 27 (02) 417-427
55 Kennedy ED, Simunovic M, Jhaveri K. et al. Safety and feasibility of using magnetic resonance imaging criteria to identify patients with “good prognosis” rectal cancer eligible for primary surgery: the phase 2 nonrandomized QuickSilver clinical trial. JAMA Oncol 2019; 5 (07) 961-966
56 Garcia-Aguilar J, Patil S, Gollub MJ. et al. Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy. J Clin Oncol 2022; 40 (23) 2546-2556
57 Luna-Pérez P, Rodríguez-Ramírez S, Hernández-Pacheco F, Gutiérrez De La Barrera M, Fernández R, Labastida S. Anal sphincter preservation in locally advanced low rectal adenocarcinoma after preoperative chemoradiation therapy and coloanal anastomosis. J Surg Oncol 2003; 82 (01) 3-9
58 Lorenzi B, Brading AF, Martellucci J, Cetta F, Mortensen NJMC. Short-term effects of neoadjuvant chemoradiotherapy on internal anal sphincter function: a human in vitro study. Dis Colon Rectum 2012; 55 (04) 465-472
59 Da Silva GM, Berho M, Wexner SD. et al. Histologic analysis of the irradiated anal sphincter. Dis Colon Rectum 2003; 46 (11) 1492-1497
60 Ito M, Saito N, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y. Analysis of clinical factors associated with anal function after intersphincteric resection for very low rectal cancer. Dis Colon Rectum 2009; 52 (01) 64-70
61 Sensi B, Bagaglini G, Bellato V. et al. Management of low rectal cancer complicating ulcerative colitis: proposal of a treatment algorithm. Cancers (Basel) 2021; 13 (10) 2350
62 Lightner AL, Spinelli A, McKenna NP, Hallemeier CL, Fleshner P. Does external beam radiation therapy to the pelvis portend worse ileal pouch outcomes? An international multi-institution collaborative study. Colorectal Dis 2019; 21 (02) 219-225
63 Kiely JM, Fazio VW, Remzi FH, Shen B, Kiran RP. Pelvic sepsis after IPAA adversely affects function of the pouch and quality of life. Dis Colon Rectum 2012; 55 (04) 387-392
64 Widmar M, Munger JA, Mui A. et al. Diverted versus undiverted restorative proctocolectomy for chronic ulcerative colitis: an analysis of long-term outcomes after pouch leak short title: outcomes after pouch leak. Int J Colorectal Dis 2019; 34 (04) 691-697
65 Wertzberger BE, Sherman SK, Byrn JC. Differences in short-term outcomes among patients undergoing IPAA with or without preoperative radiation: a National Surgical Quality Improvement Program analysis. Dis Colon Rectum 2014; 57 (10) 1188-1194
66 Green S, Stock RG, Greenstein AJ. Rectal cancer and inflammatory bowel disease: natural history and implications for radiation therapy. Int J Radiat Oncol Biol Phys 1999; 44 (04) 835-840
67 Willett CG, Ooi CJ, Zietman AL. 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 (04) 995-998
68 Song DY, Lawrie WT, Abrams RA. et al. Acute and late radiotherapy toxicity in patients with inflammatory bowel disease. Int J Radiat Oncol Biol Phys 2001; 51 (02) 455-459
69 Peters CA, Cesaretti JA, Stone NN, Stock RG. 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 (02) 424-429
70 Glick D, Warde P, Su J, Xu W, Milosevic MF, Kim J. Gastrointestinal toxicity in patients with inflammatory bowel disease treated with pelvic radiation therapy. Int J Radiat Oncol Biol Phys 2014; 90 (01) S388-S389
71 Chang BW, Kumar AM, Koyfman SA, Kalady M, Lavery I, Abdel-Wahab M. Radiation therapy in patients with inflammatory bowel disease and colorectal cancer: risks and benefits. Int J Colorectal Dis 2015; 30 (03) 403-408
72 Rhome RM, Axelrad JE, Itzkowitz SH. et al. Acute and chronic complications after abdominal/pelvic radiation in patients with inflammatory bowel disease. Int J Radiat Oncol Biol Phys 2015; 93 (03) E492
73 Gestaut MM, Swanson GP. Long term clinical toxicity of radiation therapy in prostate cancer patients with inflammatory bowel disease. Rep Pract Oncol Radiother 2017; 22 (01) 77-82