Intestinal malabsorption in long-term survivors of cervical cancer treated with radiotherapy

The aim of this cross-sectional study is to investigate the associations between pelvic radiotherapy (RT) and markers of intestinal absorption in cervical cancer survivors (CCSs). We compared patient data with normative data from a reference population and explored the associations between cobalamin status and clinically significant diarrhea and depression.

Fifty-five CCSs treated with RT in 1994-1999 were included in 2005 in a follow-up questionnaire study exploring physical and psychological symptoms. Blood tests, including serum (S)-vitamin B(12,) S-methylmalonic acid, S-folate, erythrocyte-folate, and plasma homocysteine, were analyzed. Differences in median values between CCSs and reference populations were evaluated by using Wilcoxon tests. Associations between variables were examined by means of multiple regression analyses.

Median S-vitamin B(12) level was significantly lower and median S-methylmalonic acid level was significantly higher in CCSs compared with the reference population (p < 0.001). Correction for renal function verified a likely cobalamin deficiency in 20% of CCSs (11 of 55). Diarrhea or depression was not significantly related to any of the mentioned markers of cobalamin or folate status. Fifteen percent of CCSs (8 of 55) had subnormal S-calcium values.

Significant cobalamin deficiency was observed in 11 (20%) and low calcium level was observed in 8 CCSs (15%) 6-12 years after pelvic RT. Neither diarrhea nor depression was associated with this deficiency. Routine monitoring of S-vitamin B(12) level is recommended, and regular intake of cobalamin should be considered in CCSs treated with RT.