Effect of endoscopic treatment for lesions in radiotherapy field after radiotherapy for rectal cancer.

backgroundLesions manifesting after radiotherapy are difficult to treat. Significant inflammations often manifest at the rectal wall after radiotherapy, the rectal wall often experiences significant inflammation, and the intestinal cavity is typically in an edematous state.

methodsThis retrospective study included 22 patients who had previously undergone radiotherapy or chemoradiotherapy and subsequently developed rectal lesions. All patients underwent either endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for lesion removal. Data on demographics, treatment modalities, time to lesion detection, lesion characteristics, and clinical outcomes were collected. The safety and efficacy of the endoscopic treatments were evaluated, with follow-up information gathered through in-person interviews and telephone calls.

resultsThe mean age of 22 patients was 62.1 years, and the mean time to lesion detection after initial treatment was 90.6 months post-initial treatment. Most patients (77.3%) had a single lesion, and EMR or ESD were successfully performed with no major postoperative complications. Most lesions were adenomas (90.3%). 72.7% of patients were alive during the entire follow-up period, and 13.6% survived for more than 5 years. No significant complications, such as perforation or bleeding, were reported.

conclusionEndoscopic resection with EMR and especially ESD appears feasible and safe for selected patients with small rectal lesions after radiotherapy. These preliminary findings highlight the importance of endoscopic surveillance for early detection and timely management. Larger multicenter studies are warranted to validate the feasibility and safety of this approach and to better define its long-term outcomes.