Appendicitis during locoregional thermoradiotherapy of advanced or recurrent rectal and cervical cancer, a report of two cases

Abstract

Introduction : Local tumour control after irradiation alone for advanced, inoperable carcinomas of the bladder and rectum or inoperable recurrent cervical carcinoma is usually disappointing. Both preclinical and clinical studies reported improvements by adding hyperthermia to radiotherapy. Reports for phase II/ III trials do not indicate any enhanced side effects. However, two cases of acute suppurating appendicitis were observed in a series of patients treated with deep regional hyperthermia. Materials, methods and results : Eighty patients with advanced, inoperable, or recurrent rectal or recurrent cervical tumours were treated with deep regional hyperthermia (313 sessions) in addition to radiotherapy between September 1995 and October 1998. The treatment for two of these patients (2.5%) had to be discontinued after the fourth/second hyperthermia treatments at 19.8/10.8Gy total dose, respectively, for symptoms of pain in the right pelvis and elevated rectal temperature. Both patients underwent laparotomy and were found to have suppurative appendicitis. In addition to the retrocoecal location in both patients, evidence of preexisting chronic appendicitis, and appendiceal faecalith were observed in each patient. Conclusion : The development of acute appendicitis in 2.5% of patients during a course of deep regional thermoradiotherapy for pelvic tumour is much higher than the expected incidence of appendicitis in the general population (< 10/00) (Korner et al. 1997). An enhanced risk of suppurative appendicitis in patients undergoing pelvic thermoradiotherapy cannot be excluded, especially in retrocoecal located appendices with obstructed appendix lumen from preexisting chronic appendicitis or faecalith.

• Thermoradiotherapy;Hyperthermia;Appendicitis;Side-effects