What is Pelvic Radiation Disease? (PRD) 

Pelvic Radiation Disease is defined as any, brief or longlasting problems, which can be anything from very mild to very severe, arising in normal, non cancerous tissues and which start as a result of radiotherapy to a tumour in the pelvis.

How common is PRD? 

In the UK 17,000 patients are treated with radiotherapy to the abdomen and pelvis for cancer. 90% develop some bowel upset during treatment but this often settles or remains minor when treatment finishes.  50% develop gastro-intestinal symptoms which affect quality of life and range from minor inconvenience to being house-bound.  Approximately one quarter will develop sexual or urinary problems.  Some people might go on to have long term damage to their bones, skin or lymph drainage from the legs.

How do I know if I have pelvic radiation disease? 

People who develop new symptoms affecting the bowel, urinary tract, sex organs, bones, or skin, during or after radiotherapy may have Pelvic Radiation Disease. Other diseases can start after radiotherapy, so people need to be properly assessed to establish the causes of symptoms.

How long after radiotherapy treatment does PRD occur? 

Any time following radiotherapy but sometimes side effects aren’t evident for months or years.

Are there other names for PRD? 

Yes, the late or side effects of pelvic radiotherapy or the consequences of treatment of pelvic radiotherapy.

My medical team has never heard of pelvic radiation disease – What do you suggest I do? 

Take the information from this website to your GP to discuss the possibility of PRD.  Ask to be referred to a gastroenterologist. See our documents section  for clinical guidelines on how to treat PRD.

Can PRD be treated? 

Symptoms of constipation, diarrhoea, frequency of stool, increased gas, erratic bowel, greasy stool, abdominal pain, bloating, rectal pain, faecal incontinence, and often rectal bleeding can usually be improved or cured by using a combination of life style changes and medication depending on the exact causes.  Specific conditions caused by damaged tissues such as bile acid malabsorption, lactose intolerance or functions of the bowel such as small intestinal bacterial overgrowth respond to specific treatments.

Some doctors increasingly believe that some of the changes in tissues which lead to the symptoms of pelvic radiation disease may be reversible. As yet, the available treatments are experimental but the most promising ones include hyperbaric oxygen, vitamin E with pentoxyfilline and possibly statins and a group of drugs called ACE inhibitors. However, much more research needs to be done before these can be recommended for widespread use.

The majority of people affected are found by PRD clinics to have three or more diagnoses contributing to their symptoms, and even expert clinicians are almost never correct in predicting the correct combination of underlying problems from the patient’s story and need to arrange the appropriate tests.

Units experienced in treating the symptoms of patients with PRD find that their best results seem to come when they very strictly follow a detailed algorithm of what tests to do and what treatments to offer, and take no short cuts.  The algorithm was developed at the Royal Marsden Hospital and can be accessed via this link.

What is hyperbaric oxygen therapy? 

HBO has been used for many years for radiation damage.  A trial in the USA – the HORTIS trial – suggested it could be helpful for PRD,  while  the recently completed UK study – the HOT II trial – very disappointingly showed no benefit at all from hyperbaric oxygen.   Further trials are definitely needed but as a result of the UK study hyperbaric oxygen treatment which is very expensive seems to be at best a long shot.

 

If you have more questions please contact us and we will try to send you further information.