Pelvic Intensity-modulated Radiotherapy: Can we Better Quantify the Late Side-effects?

Increasingly, the prevention and management of radiotherapy side-effects have become a fundamental part of the care given to patients diagnosed with cancer. Pelvic IMRT in anal cancer allows sparing of normal tissues, such as genitalia, bowel and bladder, at least in terms of dose-volume data [2]. However, the effect on patient outcomes is what matters and for this reason it is important to quantify toxicity in these structures and collect specific data to provide a baseline against which the outcomes for future technical developments can be compared. Furthermore, at the present time we have few quantitative data to provide patients with more details regarding expected long-term consequences and to ensure that consent is truly informed [1e3]. We conducted a post-IMRT follow-up on a cohort of patientsdiagnosedwithanalcancerandtreatedwithIMRTsince late 2010 to assess late side-effects and chronic symptoms. We used validated questionnaires including Inflammatory Bowel Disease Questionnaire (IBDQ), IBDQ-B, Vaizey and a pelvic symptom questionnaire, which take into account not only symptoms but also the patient’s feelings and perception of disease and side-effects, and the effect on normal life [4,5]. From a preliminary analysis of our data, most patients maintained good bowel continence and the treatment was also well tolerated in terms of genitalia toxicity. Over a 3 year follow-up period, IBDQ, IBDQ-B and Vaizey scores appeared to be either stable or improving, indicating no progressive change in function.