Andreyev HJN et al. (2005) Gastrointestinal symptoms after pelvic radiotherapy: role for the gastroenterologist? Int J Radiat Oncol Biol Phys 62: 1464–1471

Many patients who have undergone radiotherapy for pelvic malignancies develop gastrointestinal symptoms (radiation enteritis) as a side effect that can affect their quality of life, but referral to a gastroenterologist is not routine procedure in the UK. A new study by Andreyev and colleagues at the Chelsea and Westminster and Royal Marsden Hospitals highlights the importance of this issue, and the authors have proposed a novel algorithm for gastroenterological investigation in these patients.

Data were prospectively recorded from a consecutive series of 265 patients who had received radiotherapy for pelvic cancer and were referred to a gastroenterologist for investigation of gastrointestinal symptoms. Patients underwent flexible sigmoidoscopy and other standard gastrointestinal examinations. The majority of patients were diagnosed with two or more gastrointestinal conditions, and 34% of all diagnoses were unrelated to radiotherapy. Evidence of malignancy was found in 12% of patients, half of whom had recurrence of their original pelvic tumor. Symptoms did not differ significantly between diagnoses related or unrelated to radiotherapy, and in multivariate analysis abdominal pain was the only symptom significantly associated with a diagnosis of neoplasia (P <0.001).

The authors conclude that radiation enteritis is a complex disease, not easily diagnosed by assessment of symptoms alone. They suggest that patients presenting with gastrointestinal symptoms after pelvic radiotherapy should be referred to a gastroenterologist and assessed according to the proposed algorithm.