Late gastrointestinal toxicity after radiotherapy for anal cancer: a systematic literature review

Figures & data

Figure 1. PRISMA flowchartof literature search and selection.

Table 1. Results of anorectal manometry after radiotherapy for anal cancer.

Author (patient no.)	Age	T1–2 (%)	Radiotherapy technique	Dosage (EBRT/AL boost)	Median follow-up (range)	Incontinence symptoms	Manometric sphincter length (cm)	Resting pressure (mm Hg)	Maximum squeeze pressure (mm Hg)	Relaxation of internal anal sphincter (%)	Rectal compliance (ml/mm Hg)
Broens et al. 1998 (N = 8) [51]	Median 68 years 62 years (range 38–79)	50	EBRT + brachytherapy + chemotherapy (25%)	44 ± 3 Gy/20 ± 4 Gy	43 months (range 25–83)	Incontinent for flatus and urgency of liquid stools: 4/8 (50%) Urgency of solid: 3/8 (37.5%)	3 (2.2–3.1)	50* (30–65)	163* (120–235)	–	1.5* (0.7–2.5)
Vordermark et al. 1999 (N = 16) [29]	mean 70 ± 16  years	82	EBRT + brachytherapy + chemotherapy	5 days/week (single dose 1.8 or 2.0 Gy), total brachytherapy dose 1–10 Gy	mean2.5 ± 2.2 years (0.6–7.9 years)	Completely continent:9/16 (56%) Liquid soiling 3/16 (19%) Solid soiling: 3/16 (19%) Completely incontinent: 1/16 (6%)	3.0 (2.0–5.0)	40.0* (20.0 ± 113.0)	41.0* (7.0 ± 92.0)	58.5 (33.0 ± 78.0)	2.95 (1.30 ± 7.30)
Vordermark et al. 2001 (N = 10) [52]	Median 68 years (range 47–93)	75	EBRT + intracavitary after loading boost + chemotherapy (75%)	median dose 56 Gy, range 46–64 Gy/AL one or two fractions of 5 Gy	1.5 years (1.0–7.9 years)	Complete continence: 6/10 (60%) liquid soiling: 1/10 (10%), solid soiling: 2/10 (20%) complete incontinence: 1/10 (10%)	3.0* (2.0–4.0)	39* (20–90)*	38* (7–76)*	58 (33–78)	3.5 (1.3–3.7)

EBRT: external beam radiotherapy.

* p<.05.

Eng C, Chang GJ, You YN, et al. Long-term results of weekly/daily cisplatin-based chemoradiation for locally advanced squamous cell carcinoma of the anal canal. Cancer. 2013;119:3769–3775.

 PubMed Web of Science ®Google Scholar

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;30:4344–4351.

 PubMed Web of Science ®Google Scholar

Vaizey CJ, Carapeti E, Cahill JA, et al. Prospective comparison of faecal incontinence grading systems. Gut. 1999;44:77–80.

 PubMed Web of Science ®Google Scholar