Rectal cancer after prostate radiation: A complex and controversial disease Review


Authors: Omer, D. M.; Thompson, H. M.; Verheij, F. S.; Yuval, J. B.; Rosen, R.; Beets, N. R. A.; Luthra, A.; Romesser, P. B.; Paty, P. B.; Garcia-Aguilar, J.; Sanchez-Vega, F.
Review Title: Rectal cancer after prostate radiation: A complex and controversial disease
Abstract: A small proportion of rectal adenocarcinomas develop in patients many years after the treatment of a previous cancer using pelvic radiation, and the incidence of these rectal cancers depends on the length of follow-up from the end of radiotherapy. The risk of radiation-associated rectal cancer (RARC) is higher in patients treated with prostate external beam radiotherapy than it is in patients treated with brachytherapy. The molecular features of RARC have not been fully investigated, and survival is lower compared to non-irradiated rectal cancer patients. Ultimately, it is unclear whether the worse outcomes are related to differences in patient characteristics, treatment-related factors, or tumor biology. Radiation is widely used in the management of rectal adenocarcinoma; however, pelvic re-irradiation of RARC is challenging and carries a higher risk of treatment complications. Although RARC can develop in patients treated for a variety of malignancies, it is most common in patients treated for prostate cancer. This study will review the incidence, molecular characteristics, clinical course, and treatment outcomes of rectal adenocarcinoma in patients previously treated with radiation for prostate cancer. For clarity, we will distinguish between rectal cancer not associated with prostate cancer (RCNAPC), rectal cancer in non-irradiated prostate cancer patients (RCNRPC), and rectal cancer in irradiated prostate cancer patients (RCRPC). RARC represents a unique but understudied subset of rectal cancer, and thus requires a more comprehensive investigation in order to improve its treatment and prognosis. © 2023 by the authors.
Keywords: radiation; oncology; radiation oncology; colorectal surgery; rectal cancer; surgical oncology; radiation-associated rectal cancer
Journal Title: Cancers
Volume: 15
Issue: 8
ISSN: 2072-6694
Publisher: MDPI  
Date Published: 2023-04-02
Start Page: 2214
Language: English
DOI: 10.3390/cancers15082214
PROVIDER: scopus
PMCID: PMC10136617
PUBMED: 37190143
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Francisco Sanchez-Vega -- Source: Scopus
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MSK Authors
  1. Philip B Paty
    496 Paty
  2. Paul Bernard Romesser
    189 Romesser
  3. Anisha Luthra
    26 Luthra
  4. Jonathan Benjamin Yuval
    37 Yuval
  5. Floris Stefanus Verheij
    36 Verheij
  6. Dana Mohamed Rashid Omer
    32 Omer
  7. Roni Rosen
    13 Rosen
  8. Nathalie Beets
    1 Beets