Late effects of pelvic radiation for rectal cancer and implications for survivorship

Improved treatment for colorectal cancer with better survival rates has heightened awareness of the potential late toxicities of pelvic radiation. Colorectal cancer (CRC) survivors experience inferior physical and mental quality of life (Denlinger and Barsevick, 2009 [3]). As a growing population of CRC survivors live long enough to experience normal tissue adverse effects induced or exacerbated from pelvic radiation, survivorship plans that address subsequent gastrointestinal and sexual dysfunctions are beginning to emerge. Early identification and referral for treatment interventions is important for reducing late toxicity; however, prevention is still the best practice, with clinicians optimizing patient- and treatment-specific factors. Practices that reduce irradiation of critical pelvic structures include treating locally advanced patients preoperatively with multiple beam techniques that minimize the dose delivered to the small bowel, avoiding inclusion of the anal sphincter complex for higher tumors, and maximizing testicular shielding. For younger women of childbearing age, consideration of fertility-preservation options at diagnosis is essential. In this review, we will describe the data relevant to radiation-induced late effects for rectal cancer that focus on gastrointestinal and sexual sequelae. We will also explore some potential prevention and management options for long-term treatment-related morbidity.