“Pelvic radiation disease”: New understanding and new solutions for a new disease in the era of cancer survivorship

Abstract

Background. Cancer therapies increasingly achieve cure, but result in chronic moderate or severe gastrointestinal side effects in millions of patients worldwide. Paradoxically, modern therapies threaten to increase the burden of chronic gastrointestinal toxicity, not reduce it. Aim. To define pelvic radiation disease. Methods. A reinterpretation of published data. Results. The lack of interest in patients with pelvic radiation disease is startling. Symptoms after radiotherapy are only a manifestation of new onset gastrointestinal physiological deficits induced by the radiotherapy. With proper diagnosis and treatment of these deficit(s), the symptoms are curable. Science suggests that much radiotherapy-induced gastrointestinal morbidity is preventable. Once the true nature of radiation injury is understood, straightforward solutions emerge and inaccurate dogmas can be discarded. Imprecise language is a fundamental barrier to progress in complex disorders. Conclusions. Radiation-induced gastrointestinal toxicity is bedeviled by inappropriate terminology, causing confusion, and myth which legitimizes inappropriate clinical behavior. We must address honestly the uncomfortable reality that doctors, sometimes do harm. Not to do so in an era where survivorship is a reality, will deny millions often with severe symptoms from “pelvic radiation disease”, the care which will help them.

Key Words::

• Colitis
• colopathy
• enteritis
• enteropathy
• gastrointestinal
• late effects
• proctitis
• proctopathy
• radiotherapy
• radiation
• toxicity

Acknowledgement

The concept of pelvic radiation disease was first introduced as a “commentary” in Lancet Oncology in April 2010.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.