Turina and colleagues call attention to the important clinical problem of chronic intestinal complications related to pelvic radiation. While efforts are being made to reduce the need for radiation therapy and to minimize its risk, the Kentucky data illustrate the large number of patients who receive this treatment. The authors' description of the various complications and their management raise a number of issues.
Although only 15% of patients with colorectal cancer receive radiation therapy, the frequency of this condition means that many of these patients will present with intestinal complications. Is this risk decreasing? It is not clear that more widespread use of total mesorectal excision has reduced the use of radiation therapy for rectal cancer, at least not in the United States. Preoperative therapy for rectal cancer may decrease the risk of these injuries and improve long-term bowel function. Hopefully, new delivery techniques will minimize intestinal injury.