Radiation proctitis is a frequent acute complication encountered with pelvic irradiation. This study was aimed at establishing the optimal radiation dose for radiation-induced proctitis in rats. Female Wistar rats were used. The rectal specimens were examined morphologically at 5th and 10th day following 10-30 Gy irradiation in single fraction. With increasing dose, mucosal damage became worse, and there was a prominent reaction after > or =15 Gy. We selected 17.5 Gy as an optimal dose for radiation proctitis and examined specimens at day 1-14 and at week 4, 6, 8, and 12 after 17.5 Gy. The rectal mucosa revealed characteristic histological changes with time. An edema in lamina propria started as early as 1-2 days after irradiation and progressed into acute inflammation. On day 7 and 8, regeneration was observed with or without ulcer. Four weeks later, all regeneration processes have been completed with end result of either fibrosis or normal appearing mucosa. This study showed that the radiation injury of the rectum in rat develops in dose-dependent manner as it has reported in previous studies and suggested that 17.5 Gy in single fraction is the optimum dose to evaluate the protective effect of various medications for radiation proctitis in face of the clinical situation.
Animal ; Disease Models, Animal ; Dose-Response Relationship, Radiation ; Female ; Proctitis*/pathology ; Proctitis*/mortality ; Proctitis*/etiology ; Rats ; Rats, Wistar ; Rectum/radiation effects* ; Rectum/pathology ; Time Factors

OBJECTIVES: Radiation therapy is a main method for female pelvic malignancies, which can cause some adverse reactions, such as radiation proctitis (RP). The incidence of RP is highly positively correlated with radiation dose. There is an urgent need for a scientific method to accurately predict the occurrence of RP to help doctors make clinical decisions. In this study, based on the clinical data of female pelvic tumor patients and dosimetric parameters of radiotherapy, the random forest method was used to screen the hub features related to the occurrence of RP, and then a machine learning algorithm was used to construct a risk prediction model for the occurrence of RP, in order to provide technical support and theoretical basis for the prediction and prevention of RP. METHODS: A total of 100 female patients with pelvic tumors, who received static three-dimensional conformal intensity-modulated radiation therapy in the Department of Radiation Oncology of the Affiliated Hospital of Xiangnan University from January 2019 to December 2020, were retrospectively collected, and their clinically relevant data and radiotherapy planning system data were collected. During radiotherapy and 18 months after radiotherapy, 35 cases developed RP (RP group), and the remaining 65 cases had no RP (non-RP group). The clinical and dosimetric characteristics of patients were ranked by the importance of random forest algorithm, and the independent prognostic characteristics associated with the occurrence of RP were selected for machine learning modeling. A total of 6 machine learning algorithms including support vector machines, random forests, logistic regression, lightweight gradient boosting machines, Gaussian naïve Bayes, and adaptive enhancement were used to build models. The performance of the model was evaluated by the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F1 score. Finally, the random forest model was determined as the prediction model, and the calibration curve and decision curve of the prediction model were drawn to evaluate the accuracy and clinical benefit of the model. RESULTS: The parameters for random forest prediction model in the training set were as follow: AUC, 1.000, accuracy, 0.988, sensitivity, 1.000, specificity, 1.000, positive predictive value, 1.000, negative predictive value, 0.981, and F1 score, 1.000. In validation set, AUC was 0.713, accuracy was 0.640, sensitivity was 0.618, specificity was 0.822, positive predictive value was 0.500, negative predictive value was 0.656, and F1 score was 0.440. Random forest showed high predictive performance. Moreover, the Brief of the calibration curve for the prediction model was 0.178, the prediction accuracy was high, and the decision curve showed that the prediction model could benefit clinically. CONCLUSIONS Based on the clinical and dosimetric parameters for the female pelvic tumor patients, the prediction model of radiation proctitis constructed by random forest algorithm has high predictive ability and strong clinical usability.
Bayes Theorem ; Female ; Humans ; Machine Learning ; Pelvic Neoplasms/radiotherapy* ; Proctitis/etiology* ; Radiation Oncology ; Retrospective Studies

Proctitis is an inflammatory change of rectal mucosa induced by various agents or stimulus. Among many etiologies, it may be caused by medical treatments such as radiation or antibiotics. Proctitis usually presents with rectal ulcer but abscess formation is uncommon. Therapy using Ssukjwahun exerts its effect by directly applying the smoke around genital area and anus with various medicinal brewed herbs, especially worm-wood. Secondary metabolite of this plant, monoterpene, is known to facilitate circulation, exert anti-inflammatory effect, and help control pain. Herein, we report an unusual case of infectious proctitis presenting with rectal ulcer and abscess formation after perianal application of warm steam made by Artemisia asiatica smoke for treatment of dysmenorrhea.
Abdomen/diagnostic imaging ; Abscess/*diagnosis ; Adult ; Artemisia/*chemistry/metabolism ; Female ; Humans ; Proctitis/*diagnosis/etiology ; Rectum/diagnostic imaging ; Sigmoidoscopy ; Smoke/*adverse effects ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVETo investigate risk factors associated with prognosis in patients with radiation proctitis (RP).

METHODSBetween August 2007 and February 2010, 33 patients diagnosed with radiation proctitis were identified. Data pertaining to treatments and quality of life(QOL) were analyzed retrospectively.

RESULTSIndication for radiation included cervical cancer(n=22), prostate cancer (n=3), ovary cancer (n=2), rectal cancer (n=2), endometrial cancer(n=2), cervical cancer (n=1), and vaginal cancer(n =1). Data regarding radiation were available in 18 patients, and the mean dose was (61.3±12.9) Gy with a median dose of 61 Gy. Eleven were treated with enema therapy, 9 formalin dab, 12 surgical operations. Clinical improvement was noticed in 75% of the patients with a mean QOL score of 63.79±20.92. Prognosis was favorable in 75% of the patients. Surgical treatment was effective in 91.7% of the patients with severe complications. Univariate analysis showed that gender was associated with the prognosis of RP, while the severity of RP and treatment method were not predictive for RP prognosis.

CONCLUSIONSGender but not disease severity is associated with the prognosis of radiation proctitis. Surgery may be beneficial to RP patients with severe complications.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Proctitis ; diagnosis ; etiology ; therapy ; Prognosis ; Radiation Injuries ; complications ; Retrospective Studies ; Risk Factors ; Treatment Outcome

Objective: To investigate the nursing care of prostate cancer (PCa) patients againstradioactive proctitisinduced byCyberKnifetreatment. METHODS: Sixty-eightPCapatients undergoingCyberKnife treatment in the observation group receivedspecialnursing care againstradioactive proctitis. The nursing measures includedthoserelevant toCyberKnife treatment, prevention ofradioactive proctitis, skin care, and discharge guidance. Meanwhile, another 54 prostate cancer patients received traditional nursing care as controls. We compared the incidence rate and severity of radioactive proctitis between the two groups of patients. RESULTS: The incidence rate of radioactive proctitiswas markedly lower in the observation group than in the control (2.9% vs 13.0%, P<0.05), but no statistically significant difference was observed in the severity of radioactive proctitis between the two groups of patients. CONCLUSIONS The special nursing care againstCyberKnife-induced radioactiveproctitiscan significantlyreduce the incidence of radioactive proctitis andimprove the effect of CyberKnife treatment of prostate cancer, which therefore deserves wide clinical application.
Case-Control Studies ; Humans ; Male ; Proctitis ; etiology ; nursing ; prevention & control ; Prostatic Neoplasms ; radiotherapy ; Radiation Injuries ; nursing ; prevention & control ; Radiosurgery ; adverse effects

PURPOSE: To investigate the difference in rectal complications rate following prostate low dose rate (LDR) brachytherapy based on prostate-rectum distance and prostate longitudinal length among early prostate cancer patients. MATERIALS AND METHODS: From March 2008 to February 2013, 245 prostate cancer patients with a Gleason score < or =7 were treated with 125-I LDR brachytherapy. Among them, 178 patients with prostate volume 20-35 mL and a follow-up period > or =6 months were evaluated for radiation proctitis. Magnetic resonance imaging (MRI) was performed for a prebrachytherapy evaluation, and prostate-rectum distance and prostate longitudinal length were measured. The radiation proctitis was confirmed and graded via colonoscopy based on the radiation therapy oncology group (RTOG) toxicity criteria. RESULTS: Twenty-three patients received a colonoscopy for proctitis evaluation, and 12 were identified as grade 1 on the RTOG scale. Nine patients were diagnosed as grade 2 and 2 patients were grade 3. No patient developed grade 4 proctitis. The rectal-complication group had a mean prostate-rectum distance of 2.51+/-0.16 mm, while non-rectal-complication control group had 3.32+/-0.31 mm. The grade 1 proctitis patients had a mean prostate-rectum distance of 2.80+/-0.15 mm, which was significantly longer than 2.12+/-0.31 mm of grades 2 and 3 patient groups (p=0.045). All 11 patients of grades 2 and 3 had a prostate longitudinal length of 35.22+/-2.50 mm, which was longer than group 1, but the difference was not statistically significant (p=0.214). CONCLUSIONS: As the prostate-rectum distance increased, fewer postimplantation rectal symptoms were observed. Patients with a shorter prostate-rectum distance in MRI should receive modified implantation techniques or radical prostatectomy.
Aged ; Brachytherapy/*adverse effects ; Carcinoma/*radiotherapy ; Colonoscopy ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Organ Size ; Proctitis/diagnosis/*etiology ; Prostate/*pathology ; Prostatic Neoplasms/*radiotherapy ; Radiation Injuries/diagnosis/*etiology ; Severity of Illness Index

BACKGROUND/AIMS: Pediatric inflammatory bowel disease (IBD) has been increasing worldwide. The characteristics of pediatric-onset IBD have mainly been reported in Western countries. We investigated the clinical characteristics of pediatric IBD in Korea and compared these with the data from the 5-year European multicenter study of children with new-onset IBD (EUROKIDS registry). METHODS: Children who were diagnosed with IBD between July 1987 and January 2012 were investigated at five Korean university hospitals. Their clinical characteristics were retrospectively evaluated by medical record review. The results were compared with the EUROKIDS data. RESULTS: A total of 30 children with Crohn's disease (CD) and 33 children with ulcerative colitis (UC) were enrolled. In comparison with the EUROKIDS group, Korean pediatric IBD patients showed a male predominance (86.7% vs 59.2%, p=0.002 in CD; 75.8% vs 50%, p=0.003 in UC). Korean pediatric CD patients had a higher prevalence of terminal ileal disease (36.7% vs 16.3%, p=0.004) and perianal disease (33.3% vs 8.2%, p<0.001) than patients in the EUROKIDS group. Korean pediatric UC patients had a higher prevalence of proctitis than patients in the EUROKIDS group. CONCLUSIONS: Our results suggest that the characteristics of Korean pediatric IBD patients and European pediatric IBD patients may be different.
Adolescent ; Anus Diseases/complications/epidemiology/pathology ; Child ; Colitis, Ulcerative/complications/epidemiology/*pathology ; Crohn Disease/complications/epidemiology/*pathology ; Europe/epidemiology ; Female ; Humans ; Ileal Diseases/complications/epidemiology/pathology ; Male ; Prevalence ; Proctitis/epidemiology/etiology ; Registries ; Republic of Korea/epidemiology ; Retrospective Studies ; Sex Factors

Administration, Rectal ; Adult ; Aged ; Anti-Inflammatory Agents ; administration & dosage ; therapeutic use ; Dexamethasone ; administration & dosage ; therapeutic use ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Middle Aged ; Phytotherapy ; Powders ; Proctitis ; drug therapy ; etiology ; Radiation Injuries ; complications ; drug therapy ; Rectum ; drug effects ; pathology ; radiation effects ; Uterine Cervical Neoplasms ; radiotherapy