Radiation treatment of men with inflammatory bowel disease (IBD)

A analysis of a tumor registry in Texas challenges the notion that men suffering from inflammatory bowel disease ought not have radiation therapy for prostate cancer.  Gestault and Swanson presented their findings at the recent ASCO Genitourinary Conference (Abstract 15). They searched a tumor registry and found 18 patients who suffered from inflammatory bowel disease (either Crohn’s disease or ulcerative colitis) and were treated with radiation between 2000 and 2010.

• ·      12 were treated with EBRT – either IMRT or 3D-CRT
• ·      6 were treated with low dose rate brachytherapy
• ·      22% were in remission before treatment
• ·      56% were taking a 5-ASA medication
• ·      17% were taking prednisone
• ·      6% were taking Remicade
• ·      6 patients (40%) had grade 1 diarrhea at baseline
• ·      2 had had an ostomy

After a median follow-up of 9.5 years:

• ·      4 patients (22%) had grade 1 diarrhea, none of higher grade
• ·      3 patients (17%) had grade 2 proctitis, none of higher grade

o   All of those had 3D-CRT, rather than IMRT

The authors conclude:

“Our findings suggest that IBD patients experience minimal toxicity with IMRT-based radiation therapy.”

While a study of 18 patients is far too small to draw any projectable conclusions, it does raise the interesting hypothesis that patients with IBD should not automatically be ruled out for primary radiation treatment. It might be prudent, however, to use a rectal spacer with such patients.