Radiation; Neoplasm; Rectum; Incontinence; Function; Outcome; Fonction; Devenir; Irradiation; Cancer
Abstract :
[fr] Le traitement adjuvant des cancers du rectum a pour buts
de stériliser la maladie résiduelle infra-clinique et
d’améliorer le contrôle local. Depuis plus de 20 ans, des
milliers de malades ont été inclus dans des études randomisées,
visant d’abord à mettre en évidence un gain de survie et une
réduction des récidives loco-régionales, en relation avec la
radiothérapie pré- ou postopératoire, combinée ou non à la
chimiothérapie. Les conséquences en termes de qualité de vie de
ces traitements ont pourtant été peu étudiées, et la tolérance
fonctionnelle du néo-rectum et de l’appareil sphinctérien à la
radiothérapie restent mal connues [1]. Les difficultés liées à
l’étude des effets de l’irradiation sur les tissus normaux, ainsi que
la variabilité inter-individuelle de la réponse à la radiothérapie,
s’ajoutent et rendent le sujet plus complexe encore.
Les radiothérapeutes adaptent leur technique afin de réduire
autant que possible la dose administrée aux tissus normaux
avoisinant la tumeur. Dans le cas de l’irradiation du petit bassin,
c’est l’intestin grêle qui a longtemps été considéré comme la
structure à risque de complications, alors que l’atteinte du
sphincter anal était rarement mentionnée [2]. Malgré les répercussions
importantes de la dysfonction ano-rectale sur la qualité
de vie des malades, l’atteinte du sphincter anal par la radiothérapie
est restée un aspect négligé du traitement adjuvant des
cancers du petit bassin [3]. Cet article a pour but, à travers une
revue de la littérature, de mettre en évidence les effets qualitatifs
et quantitatifs de la radiothérapie sur la fonction du sphincter
anal, ainsi que de proposer une modification de la technique
actuelle d’irradiation des cancers du bas rectum.
Disciplines :
Hematology Oncology
Author, co-author :
Gervaz, P; Centre Hospitalier Universitaire Vaudois (CHUV)
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