Clinicopathological characteristics and outcomes of metachronous rectal cancer in patients with a history of cervical cancer with and without remote radiotherapy: Reports of 45 cases

Hsinyuan Hung, Jengfu You, Jyming Chiang, Paoshiu Hsieh, Sumfu Chiang, Chengchou Lai, Wensy Tasi, Chienyuh Yeh, Yihjong Chern, Yujen Hsu, Hsinyuan Hung, Jengfu You, Jyming Chiang, Paoshiu Hsieh, Sumfu Chiang, Chengchou Lai, Wensy Tasi, Chienyuh Yeh, Yihjong Chern, Yujen Hsu

Abstract

The purpose of this study was to report the clinicopathological characteristics and treatment outcomes of 45 rectal cancer patients who have a history of cervical cancer with or without remote radiotherapy. Twenty-nine patients (64.4%) with a history of cervical cancer treated with pelvic radiotherapy were classified as group A, 16 (35.6%) patients with a history of cervical cancer not treated with radiotherapy were classified as group B. The median duration between radiotherapy for cervical cancer and rectal adenocarcinoma diagnosis was 18 years. At the time of rectal cancer diagnosis, 5 (17.2%) patients presented stage I disease, 15 (51.7%) had stage II, 1 (3.4%) had stage III, and 8 (27.6%) had stage IV. The patients in group A had older age, higher rates of gross ulcerative lesions, low hemoglobin levels, and a lower rate of lymph node metastases. The patients with secondary rectal cancer developed after radiotherapy for cervical cancer usually presented with abnormal abdominal symptoms, such as proctitis, cystitis, or rectal fistula. Higher colostomy rate was found in this group of patients due to severe pelvic fibrosis or proctitis.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Secondary rectal adenocarcinoma presented with large deep ulceration but no grossly tumor.
Figure 2
Figure 2
Secondary rectal adenocarcinoma presented with fistula between rectum and urinary bladder (arrow), no typical gross ulcerated tumor.
Figure 3
Figure 3
Kaplan-Meier survival analysis. Overall survival of 2 groups.

References

    1. Sont WN, Zielinski JM, Ashmore JP, et al. First analysis of cancer incidence and occupational radiation exposure based on the national dose registry of Canada. Am J Epidemiol 2001;153:309–18.
    1. Boice JD, Day NE, Anderson A, et al. Second cancers following radiation treatment for cervical cancer. An international collaboration among cancer registries. J Natl Cancer Inst 1985;74:955–75.
    1. Ron E. Ionizing radiation and cancer risk: evidence from epidemiology. Radiat Res 1998;150:S30–41.
    1. Slaughter DP, Southwich HW. Mucosal carcinoma as a result of irradiation. Arch Surg 1957;74:420–9.
    1. Castro EB, Rosen PP, Quan SHQ. Carcinoma of large intestine in patients irradiated for carcinoma of cervix and uterus. Cancer 1973;31:45–52.
    1. Neugut AI, Ahsan H, Robinson E, et al. Bladder carcinoma and other second malignancies after radiotherapy for prostate carcinoma. Cancer 1997;179:1600–4.
    1. Wright JD, Clair CM, Deutsch I. Pelvic radiotherapy and the risk of secondary leukemia and multiple myeloma. Cancer 2010;116:2486–92.
    1. Kleinerman RA, Boice JD, Jr, Storm HH, et al. Second primary cancer after treatment for cervical cancer. An international cancer registries study. Cancer 1995;76:442–52.
    1. Chen CY, Lai CH, Lee KD, et al. Risk of second primary malignancies in women with cervical cancer: a population-based study in Taiwan over a 30-year period. Gynecol Oncol 2012;127:625–30.
    1. Teng CJ, Huon LK, Hu YW, et al. Secondary primary malignancy risk in patients with cervical cancer in Taiwan: a nationwide population-based study. Medicine 2015;94:e1803.
    1. Edge SB, Byrd SR, Compton CC, et al. AJCC Cancer Staging Manual. 7th ed2010;New York: Springer-Verlag, 143–164.
    1. Ohno T, Kato S, Sato S, et al. Long-term survival and risk of second cancers after radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys 2007;69:740–5.
    1. Thompson DE, Mabuchi K, Ron E, et al. Cancer incidence in atomic bomb survivors. Part II: Solid tumors, 1958–1987. Radia Res 1994;137: 2 Suppl: S17–67.
    1. Jao SW, Beart RW, Jr, Reiman HM, et al. Colon and anorectal cancer after pelvic irradiation. Dis Colon Rectum 1987;30:953–8.
    1. Kendal WS, Eapen L, Macrae R, et al. Prostatic irradiation is not associated with any measurable increase in the risk of subsequent rectal cancer. Int J Radiat Oncol Biol Phys 2006;65:661–8.
    1. Baxter NN, Tepper JE, Durham SB, et al. Increased risk of rectal cancer after prostate radiation: a population-based study. Gastroenterology 2005;128:819–24.
    1. Eifel PJ, Levenback C, Wharton JT, et al. Time course incidence of late complications in patients treated with radiation therapy of FIGO stage IB carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 1995;32:1289–300.
    1. Coia LR, Myerson RJ, Tepper JE. Late effects of radiation therapy on the gastrointestinal tract. Int J Radiat Oncol Biol Phys 1995;31:1213–36.
    1. Holm T, Singnomklao T, Rutqvist LE, et al. Adjuvant preoperative radiotherapy in patients with rectal carcinoma. Adverse effects during long term follow-up of two randomized trials. Cancer 1996;78:968–76.
    1. Dasu A, Toma-Dasu I, Olofsson J, et al. The use of risk estimation models for the induction of secondary cancers following radiotherapy. Acta Oncol 2005;44:339–47.
    1. Tsuji T, Nakagoe ST, Hidaka TS, et al. Genetic analysis of radiation-associated rectal cancer. J Gastroenterol 2003;38:1185–8.
    1. Tamai O, Nozato E, Miyazato H, et al. Radiation-associated rectal cancer: report of four cases. Dig Surg 1999;16:238–43.
    1. Mitra D, Catalano PJ, Cimbak N, et al. The risk of lymphedema after postoperative radiation therapy in endometrial cancer. J Gynecol Oncol 2016;27:e4.
    1. Huvos AG, Woodard HQ, Cahan WG, et al. Postradiation osteogenic sarcoma of bone and soft tissues. A clinicopathologic study of 66 patients. Cancer 1985;15;55:1244–55.

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