Craniospinal XRT and Radiation Colitis

[zzcherab]

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Hope I'm not violating HIPPA. Currently doing my prelim medicine year, radonc next year. I have a patient who got craniospinal XRT, admitted to ICU for anemia secondary to GI bleed. Etiology is thought to be radiation colitis. EGD showed a small antral ulcer (really much of nothing). No colonscopy, and no RBC tagged study done. Anybody now the incidence of radiation colitis with craniospinal? Also any educational resources would be appreciated?

 

[pikachu]

Hmm...I did a Pubmed search with radiation, spinal, brain, whole brain, craniospinal, and colitis and found NADA. not a single case report. I have seen patients who got radiation in low thoracic-high lumbar spinal zones and became nauseated thereafter. I can't claim to be an expert since I'm just now on my first Rad Onc rotation (yay!) but colitis does not seem to have been reported in this setting. It's also not included when the radiation oncologist discusses potential side effects with the patient, either. If you think about it, not much of the colon lies in the path of spinal irradiation anyway since most of the length is in the lateral abdomen and then into the pelvis.

Also, if they had an ANTRAL ulcer (stomach, no?), who decided that this pt had radiation COLITIS (especially without scoping the pt)? What other diagnostic tests have been done? I've definitely seen people in other fields automatically chalking patient problems up to radiation therapy without working them up for other conditions...

 

[stephew]

Hope I'm not violating HIPPA. Currently doing my prelim medicine year, radonc next year. I have a patient who got craniospinal XRT, admitted to ICU for anemia secondary to GI bleed. Etiology is thought to be radiation colitis. EGD showed a small antral ulcer (really much of nothing). No colonscopy, and no RBC tagged study done. Anybody now the incidence of radiation colitis with craniospinal? Also any educational resources would be appreciated?

its not comon because of the dose to the bowel which is limited for two reasons:
1) the spinal port is PA
2)the dose is fairly low because of the limitations of the cord. Dose tolerance to the antrum is higher than the dose this person's antrum likely got.

Also, a bonus point of consideration.
3) for reasons unknown, kids (if your pt is a kid) are extremely tolerant to CSA-the same therapy in an adult would be really rough.

Tell them to consult the radonc team in the hospital.If its not in the prior rt fields, its definitely not a rt side effect.

Be warned: docs will blame *Everything* on radiation because they dont understand it and they *think* it makes them look smart to come up with a reason, and frankly, they're scared of it and think its sort of barbaric (unlike the sophitication that is sticking a knife in someone or titrating poison).

NOte someone did a a search on "wholebrain" and colitis. Unless the therapist had a really bad day, whole brain xrt itself wont touch the bowel (unlike the steroids said patient is on). Which brings me to my final issue with this case: was the pt on steroids by chance?

 

[zzcherab]

Patient is on decadron and proton pump inhibitor. But also recently placed on NSAID for pleurtic chest pain associated with opportunisitc pneumonia. So alot of possible causes for GI bleed.

Yeah, the same patient was having some "hallucinations" and the medicine docs tried to blame RT. I told them that it was highly unlikely, and that it was probably due to the all the opiods and benzo's the patient was on. But I'm just a tern.

 

[stephew]

Patient is on decadron and proton pump inhibitor. But also recently placed on NSAID for pleurtic chest pain associated with opportunisitc pneumonia. So alot of possible causes for GI bleed.

Yeah, the same patient was having some "hallucinations" and the medicine docs tried to blame RT. I told them that it was highly unlikely, and that it was probably due to the all the opiods and benzo's the patient was on. But I'm just a tern.

re; Hallucinations: Safe money goes with the steroids +/- narcs, +/- swelling (which RT can exaserbate- but unlikely that it wouldnt present with headache n/v ect and other signs of increased ICP first). It can also be infection. It can also be infection with subsequent increased need for steroid causing essentially an adrenal insufficiency picture that wans't an issue before infection. the PPI is great but still decadron (+ NSAID) are more likely your culprit than RT particualrly if s/he is still under tx. These are my thoughts only from what you've said above and of course can not be taken as an offical medical opinion as I do not know this patient or the case.
Good job.