Pelvic complications after interstitial and external beam irradiation of urologic and gynecologic malignancy

Pelvic malignancies comprise 19% and 28% of all malignancies in the female and male, respectively. The majority of gynecologic and urologie pelvic malignancies are treated with radiation therapy either alone or in combination with surgery either as definitive or palliative therapy. The pelvic organs, therefore, are at risk for injury by pelvic radiation. We have reviewed our experience and that of the literature with regard to the incidence of injury associated with pelvic irradiation and give recommendations for management. The most frequent and severe complications occur in association with cystectomy performed for carcinoma of the bladder that has failed definitive radiation therapy and in association with radiotherapeutic and surgical treatment of carcinoma of the cervix. We have found an 11% incidence of bowel injury following planned integrated preoperative radiation followed by cystectomy. In our experience, bowel and urinary complications secondary to external beam radiation or 125 I brachytherapy for definitive treatment of carcinoma of the prostate are very similar. The morbidity of external beam radiation therapy has been reduced using a triple‐course fractionated protocol. Rectal ulceration requiring colostomy has occurred in approximately 3% of patients treated with external beam or interstitial 125 I therapy. Surgical correction of rectal fistulas using vascularized flaps has been successful after 125 I injury but has not been possible after external beam injury. Urethral complications associated with definitive external beam radiation therapy for carcinoma of the prostate are most often associated with prior transurethral resection. They can be significantly reduced by withholding initiation of therapy for 4–6 weeks after completion of transurethral resection .