Abstract

Safety of Pelvic and Abdominal Radiation Therapy for Patients With Inflammatory Bowel Disease: A Dosimetric Analysis of Acute Bowel Toxicity

Int J Radiat Oncol Biol Phys. 2025 Feb 1;121(2):442451. doi:10.1016/j.ijrobp.2024.09.005.Epub 2024 Sep 11.

Jennifer C Hall 1Abbie K Hall 1Yuliia Lozko 1Caressa Hui 1Claire C Baniel 1Scott Jackson 1Lucas K Vitzthum 1Daniel T Chang 2Elham Rahimy 1Erqi L Pollom 3

 
     

Author information

1Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.

2Department of Radiation Oncology, Michigan University School of Medicine, Ann Arbor, Michigan.

3Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California. Electronic address: erqiliu@stanford.edu.

Abstract

Purpose: Inflammatory bowel disease (IBD) has been considered a relative contraindication to radiation therapy (RT) because of the potential greater risk of RT-induced toxicities. This study aimed to assess acute toxicity outcomes in patients with IBD treated with abdominal/pelvic RT.

Methods and materials: After institutional review board approval, patients with IBD who received RT to the abdomen/pelvis were identified from an institutional research repository, and their electronic medical records were reviewed. The IBD cohort was matched 1:1 with controls according to all of the following: RT, gender, disease site, age, and year of RT. Acute toxicity was defined as toxicity occurring within 3 months of RT. Primary outcomes were assessed via univariable logistic regression models and the predicted probability of acute toxicity and acute gastrointestinal (GI) toxicity were plotted for the most significant covariates. IBD and control cohorts were compared on demographic and toxicity variables using χ2/Fisher exact tests and Kruskal-Wallis tests where appropriate.

Results: We identified 62 patients with a median age of 64 years (IQR, 54-70 years) who received RT from 2006 to 2022. Patients were treated with intensity modulated RT (38; 61.3%), 3-dimensional conformal RT (12; 19.4%), and stereotactic body RT/brachytherapy (12; 19.4%). After RT, 28 (45.2%) and 23 (37.1%) patients experienced grade ≥2 acute (any) and acute GI toxicity, respectively. Higher overall RT dose and RT dose to small bowel were found to be significantly associated with increased risk of grade ≥2 acute toxicities (OR, 1.041 per unit Gy; 95% CI, 1.005-1.084; P = .034 and OR, 1.046; 95% CI, 1.018-1.082; P = .003, respectively). Between IBD and control cohorts, there were no significant differences in grade ≥2 acute (any) and acute GI toxicities (P = .710 and P = .704, respectively).

Conclusions: In patients with IBD treated with abdominal/pelvic RT for malignancy, RT was effective and well-tolerated. RT treatment planning should carefully consider the location(s) of IBD inflammation and dose to bowel structures, in particular, dose to the small bowel.

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