Severe late intestinal complications after abdominal and/or pelvic external irradiation with high energy photon beams

A total of 264 patients were treated between January 1981 and December 1985 for abdominal and/or pelvic tumours with high energy photon beams. Pelvic irradiation encompassed the true pelvis with upper limit located at the L5-S1 junction for 126 patients, at the L4-L5 junction for 107 patients with only 31 patients receiving external irradiation with treatment fields extending up to T12. The dose delivered to the pelvis was in the range 40-50 Gy with 72 (27.27%) patients receiving an extra dose on limited volumes up to 60-65 Gy. Acute intestinal reactions were observed in 38 (14%) patients. Using the Chassagne grading, we observed 14 grade 1,9 grade 2,13 grade 3 and 2 grade 4 late intestinal complications. Incidence of severe late intestinal complications in our series was 5.67% (15/264). Among these 15 patients three died of progression of the disease outside the treated volume, two died because of intestinal complications and/or their treatment and two died of unknown reasons. The remaining eight patients are alive with no evidence of the disease but with marked impairment of their intestinal functions. The analysis of risk factors showed only previous surgery (with laparotomy) to be significant, whereas age, delivered dose and treatment field and marked obesity had no influence on incidence of severe late intestinal complications.