Expert: Claes-Gustaf Nordquist, M.D. - 4/11/2006

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What is the normal window of healing time for 75 Grays exposure to rectum/bowel/colon? I am still suffering from  "colitis" 11 mo. after Radiation/Surgery/Antibiotic Therapy/Radiatiion which developed within 48 hrs discharge in May 05. My irradiated upper thigh epidermis is still extremely sensitive to the slightest pain and purple-brown in color, what can I expect of the condition of my colonic tissues which received the same dose (no shielding)
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75 Grays is a very high dose indeed = 7500 rads ("old fashioned" unit I learned to use when I was new to this business around 37 years ago), full dose is normally around 6000 rads = 60 Grays. To begin with your skin. What you have there is a rest condition in your skin after a strong radiation induced inflammation there - similar to a SEVERE sun burn. I can NOT promise that the signs and symptoms there will disappear - though perhaps and hopefully they will become less intense over time. Your bowel problems are caused by similar effects, a kind of internal "sun burn" in your large bowel caused by the radiation used and resulting in a bowel inflammation (= "colitis"). Due to my inexperience(in spite of all these years)with such a high dose level in this area in this way (most unusual) I can not promise you anything. Given the long period of your problems it is probably likely that they are at least partly here to stay, but I can not be sure. There is even a not insignificant risk that there may be more problems due to this in the future - it may even be necessary to remove the bowel completely and fit you with a stomia with the final part of the thin gut. I hope not, but the risk is there. Unfortunately you have not given me much information in your question so I can not go into this further. But given this very high radiation dose, I'm interested in finding out: 1. What were you treated for? 2. What was done and how? Colon cancers are usually not very sensitive to radiation - though the colon is - so radiation therapy does not normally play a large part in the therapy of colon cancers - EXCEPT with rectal cancers where it is very much of value. Please let me know the rest of your story, so I can evaluate this better!

I received  pre and post radiation for surgical resection of a very large(25 x 17 x 9.2 cm.) liposarcoma of the uppermost left thigh with three pedunculated extensions(2.2 x 1.4 x 0.9cm.)going into and above the pubic symphysis.It seems that the tumor margins were in contact with an inner portion of the pelvic bone which was surgically scraped to remove any clinging cells.During radiotherapy of the first treatment series(50 Gy) I complained about anus burns and hemorrhoids. I asked about shielding and was told it was impractical due to the massive thickness required(10 in.) and subsequent weight. During the post surgical radiotherapy(25Gy)I complained about the continuing burns to my anus (rectum attatched) and my highly burned left testicle which was pulled up and away from the target center(supposedly protecting it). I was able to deduce from the laser marks and the "aperture shadow" that cast onto the field of my body that a portion of my lower left pelvic region was either directly in the beam or so extermely close as to render it exposed (especially with no shielding).I suspect that the bowel was irritated from radiation making it sensitive to antibiotic induced (post surgial I.V.therapy)C.Difficle pos.. I no longer test pos. for C. difficle (sampling error?)but still have the hypersensitive lower bowel symptoms (frequency, looseness, malodor, urgency, general gastric unease). Nobody at the V.A. Hosp. wants to talk about it and my complaints are not to be seen in my requested copy of my medical records. Hence I have come to that great equalizer of all knowledge and information, THE INTERNET, and those generous souls that make it work for ALL the People.  Thank You sincerely ,doug phillips.
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Thanks! Then I do understand this better! In extreme situations extreme measures may be needed even be required!
I think those in charge of your therapy could not see any other choice in an effort to save your life and I sincerely hope they were right but unfortunately too early to tell! The principle lay out of the therapy was correct: presurgical radiation, followed by surgery and then postsurgical radiation. It is only the total dose that is extreme - certainly due to the size of your tumour and the seriousness of your situation. The rest was dictated by the very location of your tumour - nothing could be done about that. But those in charge should have talked to you and explained the situation - that is what informed consent is all about! And everything including your complaints should have been documented! Unfortunately those side effects you have described may be here to stay and as I wrote there may be more to come. A colostomy at least may turn out to be necessary, though I sincerely hope not.

Thank you for your indulgence of my concerns. Considering that my Liposarcoma was very slow growing (7yrs) to become so progressivly large, and with out any pain or discomfort. The two biopsies (core and incision) came back "atypical lipoma" (well differentiated celluar) which current medical/legal practice mandates a diagnosis of "Liposarcoma". It was then labeled stage 1 low grade liposarcoma (T2b,No,Mo,Gr1,stage 1). So my concern is; was this tumor, in spite of it's size, over treated? My gut feeling (no pun intended) is that the second course of radiotherapy was overkill due to lack of experience on part of a young cadre of Residents. I am not asking for you to second guess any one , but rather another point of view.       sincerely, doug phillips  

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Well, sitting here in Sweden and since I have never seen your tumour it is hard to second guess them. I'm sure they were mortally afraid that if they gave you too little and you had a relapse they would be unable to help you which probably would be the case. But I agree, it is a HUGE dose, though I understand why it was done. When you are dealing with such a big sarcoma your options are limited. However, I'm more concerned with the fact that the tumour could/was allowed to grow to such a huge size! That caused this difficult therapy situation. If treated much earlier when smaller it would have been easier though still hard!