Long-Term Endoscopic Follow-Up of Patients with Chronic Radiation Proctopathy after Brachytherapy for Prostate Cancer

Background . Chronic radiation proctopathy (CRP) is late toxicity and associated with morbidity. Aim . To investigate the predictors of prognosis in patients with CRP after brachytherapy (BT). Methods . One hundred four patients with prostate cancer were treated with BT or BT followed by external-beam radiotherapy (BT + EBRT). We retrospectively investigated the 5-year incidence of rectal bleeding and endoscopic findings of CRP using the Vienna Rectoscopy Score (VRS). Twenty patients with VRS ≥ 1 were divided into the improved VRS group without treatment, unchanged VRS group, and treated group. The parameters associated with alteration of VRS were analyzed. Results . The incidence of rectal bleeding was 24%. The risk of rectal bleeding was higher in patients treated with BT + EBRT compared to those treated with BT ( p < 0.0001). The incidence of superficial microulceration was higher in the improved VRS group than in the unchanged VRS group ( p < 0.05). The incidence of multiple confluent telangiectasia or superficial ulcers > 1 cm 2 was higher in the treated group than in both the improved and unchanged VRS groups ( p < 0.05). Conclusions . Patients treated with BT + EBRT have a high risk of CRP. Endoscopic findings were useful for prognostic prediction of CRP.