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Functional and structural changes in the anorectum following radiotherapy for urological malignancy

Hayne, Dickon; (2002) Functional and structural changes in the anorectum following radiotherapy for urological malignancy. Doctoral thesis (M.D), UCL (University College London). Green open access

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Abstract

Pelvic radiotherapy (RT) is a common treatment modality for bladder and prostate cancer. Current understanding of the effects of radiation on the anorectum is based on a limited number of studies with a paucity of prospective studies. The aetiology and extent of functional and structural anorectal injury remains unclear. The first aim of this thesis was to use in-vivo techniques and computerised RT planning predictions to determine the dose of RT received by the anorectum. The second aim of this thesis was to prospectively measure the acute effects of RT on function and structure of the anorectum using a combination of interview, anorectal physiological investigations (ARP), endoanal ultrasonography and dynamic contrast enhanced MRI and to relate dose to the changes that occurred. Thirty-two patients were recruited and 29 underwent investigations before and six weeks after radiotherapy. 18 patients underwent in-vivo dosimetry and ten patients were re-investigated six months after RT. Faecal urgency, frequency and incontinence were seen in 17(59%), 15(52%) and 9(31%) patients six weeks after RT and ARP demonstrated significantly decreased rectal sensation and rectal capacity suggesting a causative association. After RT, a reduction of 0.2mm in the thickness of the sub- epithelial layer of the anal canal on endoanal ultrasound and increased degree and rate of anal enhancement on dynamic contrast MRI (40%, 50% respectively) were seen. No functional anal canal disturbance was detected on ARP six weeks after RT. External sphincter function improved six months after RT demonstrating a degree of training of the external sphincter. Radiation doses to the anorectum were highly variable but could not be correlated with any of the functional or structural changes that were demonstrated in this study. Conclusion The functional disturbance experienced at this stage results mainly from rectal injury, though evidence for acute anal canal injury exits. Efforts to reduce symptoms should concentrate on rectal protection.

Type: Thesis (Doctoral)
Qualification: M.D
Title: Functional and structural changes in the anorectum following radiotherapy for urological malignancy
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Thesis digitised by ProQuest.
Keywords: Health and environmental sciences; Bladder cancer; Prostate cancer
URI: https://discovery.ucl.ac.uk/id/eprint/10104243
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