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Cureus 2018 Mar 13;10(3):e2317. Epub 2018 Mar 13.

Preventive Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

Background To appraise the spectrum of small bowel complications following pelvic irradiation and to assess the clinical outcome and factors associated with adverse clinical outcome in these patients. Methods This descriptive clinical study was done for three years in a tertiary care center in South India. Patients managed for post-irradiation small bowel complications, irrespective of the indication for radiotherapy, were studied. Read More

Best Pract Res Clin Gastroenterol 2016 Aug 25;30(4):655-64. Epub 2016 Jun 25.

Department of Gastrenterology, Lichtenfels Cancer Centre, Germany.

Possible toxic effects following radiation and chemotherapy of gastrointestinal tumours may cause a depletion of the mucosal barrier within the radiation volumes with severe mucositis. Diarrhoea, nausea, emesis and severe malabsorption followed by infections with dehydration and electrolyte disorders have to be encountered. For prevention and treatment of oropharyngeal mucositis an oral care protocol, oral cryotherapy together with benzydamine mouthwash may be recommended. Read More

Cancer Radiother 2016 Jul 21;20(5):416-21. Epub 2016 Jun 21.

Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France. Electronic address:

Worldwide, more than a million people receive each year a curative radiotherapy. While local control and overall survival are steadily increasing, 5 to 15% of patients still develop above grade 2 late toxicities. Late toxicities treatments are complex. Read More

Clin Colon Rectal Surg 2016 Jun;29(2):85-91

Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, Ohio.

Radiotherapy not only plays a pivotal role in the cancer care pathways of many patients with pelvic malignancies, but can also lead to significant injury of normal tissue in the radiation field (pelvic radiation disease) that is sometimes as challenging to treat as the neoplasms themselves. Acute symptoms are usually self-limited and respond to medical therapy. Chronic symptoms often require operative intervention that is made hazardous by hostile surgical planes and unforgiving tissues. Read More

Gulf J Oncolog 2014 Jul;1(16):32-9

Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 59046, Saudi Arabia.

Unlabelled: We aimed to evaluate long-term treatment outcomes and toxicity profile of postoperative radiotherapy (PORT) in Saudi women with uterine cancers.

Methods And Materials: Medical records of patients with histopathologically proven uterine cancers were reviewed and identified those who received PORT (45-50.4 Gy in 25-28 fractions) followed by vaginal brachytherapy (15-20 Gy in 3 to 4 sessions) after total abdominal hystrectomy and bilateral salpingo-oophorectomy (TAHBSO) in our center between August 2007 and April 2012. Read More

Int J Radiat Oncol Biol Phys 2014 Nov 26;90(3):595-602. Epub 2014 Sep 26.

Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain. Electronic address:

Purpose: To investigate whether polymorphisms of genes related to inflammation are associated with pathologic response (primary endpoint) in patients with rectal cancer treated with primary chemoradiation therapy (PCRT).

Methods And Materials: Genomic DNA of 159 patients with locally advanced rectal cancer treated with PCRT was genotyped for polymorphisms rs28362491 (NFKB1), rs1213266/rs5789 (PTGS1), rs5275 (PTGS2), and rs16944/rs1143627 (IL1B) using TaqMan single nucleotide polymorphism genotyping assays. The association between each genotype and pathologic response (poor response vs complete or partial response) was analyzed using logistic regression models. Read More

BMC Cancer 2014 Jan 14;14:20. Epub 2014 Jan 14.

Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.

Background: Adjuvant and salvage radiotherapy of the prostate bed are established treatment options for prostate cancer. While the benefit of an additional radiotherapy of the pelvic lymph nodes is still under debate, the PLATIN 3 prospective phase II clinical trial was initiated to substantiate toxicity data on postoperative IMRT of the pelvic lymph nodes and the prostate bed.

Methods: From 2009 to 2011, 40 patients with high-risk prostate cancer after prostatectomy with pT3 R0/1 M0 or pT2 R1 M0 or a PSA recurrence and either > 20% risk of lymph node involvement and inadequate lymphadenectomy or pN + were enrolled. Read More

Indian J Surg Oncol 2012 Dec 9;3(4):302-7. Epub 2012 Aug 9.

Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, 605006 India.

The present study was undertaken to address the various concerns that has limited the use of preoperative radiotherapy in rectal cancer in our institution. All patients diagnosed as having carcinoma rectum between August 2005 and July 2007 were included in the study. Group 1 patients consisted of those presenting with T2, T3 and T4 who received preoperative radiation of 25 Gy. Read More

Am J Clin Oncol 2014 Dec;37(6):545-9

*Istituto di Oncologia, Policlinico di Monza, Monza †Medical Oncology Unit 1 ‡Radiotherapy Unit §Statistics and Biometry Unit; Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.

Objectives: The aim of this study was to evaluate the feasibility and tolerability of capecitabine administration according to a specific time schedule, combined with adjuvant radiation therapy, in intermediate-risk to high-risk rectal cancer patients treated with an upfront surgery. The primary endpoint was the rate of grade 3 to 4 diarrhea during chemoradiation (CRT).

Materials And Methods: Stage II and III rectal cancer patients received, after total mesorectal excision, 2 cycles of XELOX regimen (oxaliplatin 130 mg/m(2) on day 1; capecitabine 1000 mg/m(2) bid on day 1 to 14, q21), followed by capecitabine (800 mg/m(2) bid daily; 20% dose at 12:00 AM and 80% dose at 12:00 PM) administered continuously during pelvic radiation (total 50. Read More

World J Gastroenterol 2013 Jan;19(2):199-208

Department of Gastroenterology, University Hospital Galway, University Hospital Galway, 34562 Galway, Ireland.

With the recent advances in detection and treatment of cancer, there is an increasing emphasis on the efficacy and safety aspects of cancer therapy. Radiation therapy is a common treatment for a wide variety of cancers, either alone or in combination with other treatments. Ionising radiation injury to the gastrointestinal tract is a frequent side effect of radiation therapy and a considerable proportion of patients suffer acute or chronic gastrointestinal symptoms as a result. Read More

World J Gastroenterol 2013 Jan;19(2):185-98

Department of Gastroenterology, University Hospital Galway, University Hospital Galway, 34562 Galway, Ireland.

Ionising radiation therapy is a common treatment modality for different types of cancer and its use is expected to increase with advances in screening and early detection of cancer. Radiation injury to the gastrointestinal tract is important factor working against better utility of this important therapeutic modality. Cancer survivors can suffer a wide variety of acute and chronic symptoms following radiotherapy, which significantly reduces their quality of life as well as adding an extra burden to the cost of health care. Read More

Undersea Hyperb Med 2012 Nov-Dec;39(6):1121-39

Radiation Oncology, University of Toledo Medical Center, Toledo, Ohio, USA.

Informal surveys at CME meetings have shown that approximately one-third of patients in the United States receive hyperbaric oxygen (HBO2) for delayed radiation injury. More than 600,000 patients receive radiation for malignancy in our country annually, and about one-half will be long-term survivors. Serious radiation complications occur in 5-10% of survivors. Read More

Clin Transl Oncol 2013 Feb 19;15(2):154-9. Epub 2012 Jul 19.

Department of Second Radiation Therapy, Saint Savvas Anticancer Institute of Athens, Athens, Greece.

Purpose: To evaluate the impact of uterine cavity's ultrasound to final selected length of intracavitary tandem. The efficacy and tolerability of external beam radiation plus HDR-Ir(192) brachytherapy in our cohort of patients were also estimated.

Materials And Methods: 48 women with locally advanced unresectable uterine cervix carcinoma were treated by HDR-Ir(192) endocavitary brachytherapy between January 2007 and January 2009. Read More

Int J Radiat Oncol Biol Phys 2012 May 12;83(1):149-57. Epub 2011 Oct 12.

Department of Clinical Pharmacology, University Medical Center, Göttingen, Germany.

Purpose: Transforming growth factor-beta1 is related to adverse events in radiochemotherapy. We investigated TGFB1 genetic variability in relation to quality of life-impairing acute organ toxicity (QAOT) of neoadjuvant radiochemotherapy under clinical trial conditions.

Methods And Materials: Two independent patient cohorts (n = 88 and n = 75) diagnosed with International Union Against Cancer stage II/III rectal cancer received neoadjuvant radiation doses of 50. Read More

Radiographics 2010 Nov;30(7):1843-56

Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Box 218, Hills Rd, Cambridge, CB2 0QQ, England.

Gynecologic malignancies account for 10%-15% of all malignancies in females. A variety of oncologic options are available depending on organ of origin, histologic diagnosis, and disease grade and stage. Gynecologic malignancies are usually treated with surgery, chemotherapy, or radiation therapy. Read More

Clin Transl Oncol 2010 Aug;12(8):554-61

Hospital Universitario de la Princesa, Madrid, Spain.

Radiation therapy in combination with other treatments, such as surgery and chemotherapy, increases locoregional control and survival in patients with thoracic, abdominal and pelvic malignancies. Nevertheless, significant clinical toxicity with combined treatments may be seen in these patients. With the advent of tridimensional conformal radiotherapy (3D-CRT), dose-volume histograms (DVH) can be generated to assess the dose received by the organs at risk. Read More

Int J Radiat Oncol Biol Phys 2011 Apr 3;79(5):1467-78. Epub 2010 Jun 3.

Department of Radiotherapy and Radiooncology, Universitätsmedizin Göttingen, Germany.

Purpose: To test for a possible correlation between high-grade acute organ toxicity during primary radiochemotherapy and treatment outcome for patients with anal carcinoma.

Methods And Materials: From 1991 to 2009, 72 patients with anal carcinoma were treated at our department (10 patients had stage I, 28 patients had stage II, 11 patients had stage IIIA, and 13 patients had stage IIIB cancer [Union Internationale Contre le Cancer criteria]). All patients received normofractionated (1. Read More

Strahlenther Onkol 2010 Jan 28;186(1):30-35. Epub 2009 Dec 28.

Department of Radiotherapy and Radiooncology, University Medicine Göttingen, Göttingen, Germany.

Purpose: To test for a possible correlation between high-grade acute organ toxicity during preoperative radiochemotherapy and complete tumor regression after total mesorectal excision in multimodal treatment of locally advanced rectal cancer.

Patients And Methods: From 2001 to 2008, 120 patients were treated. Preoperative treatment consisted of normofractionated radiotherapy at a total dose of 50. Read More

Clin Transl Oncol 2009 Aug;11(8):539-43

Department of Surgery, University Hospital Ramón y Cajal, Madrid, Spain.

Introduction: Radiation enteritis is a complication of radiation therapy for pelvic tumours. It appears after a variable period of time and is often progressive.

Material And Methods: We analyse our experience of 77 cases (52 females and 25 males) diagnosed with radiation enteritis or proctitis between 1986 and 2006. Read More

Srp Arh Celok Lek 2009 Jan-Feb;137(1-2):38-42

Introduction: Although radical radiotherapy has proved to be a successful method in prostate cancer treatment, the conventional (box) technique can result in significant adverse events.

Objective: The objective of our study was to estimate the frequency, type and severity of acute and late toxicity in radical radiotherapy of prostate cancer.

Methods: In a clinical retrospective study, we included 283 patients with histologically confirmed prostate cancer. Read More

Hong Kong Med J 2008 Aug;14(4):327-30

Department of General Surgery, Princess Royal University Hospital, Kent, United Kingdom.

We present three cases of late radiation enteritis, all admitted through the accident and emergency unit and managed in the surgical department. All presented with acute symptoms. Two had abdominal pain, nausea, and vomiting and in these two cases, plain radiology and computed tomography scans demonstrated small bowel obstruction. Read More

Zhonghua Fu Chan Ke Za Zhi 2007 Nov;42(11):733-6

Cancer Center, Third Affiliated Hospital, Third Military Medical University, Chongqing 400042, China.

Objective: To observe the three year local control rate, overall survival rate, complications and prognostic factors of endometrial cancer treated with (252)Cf neutron intracavitary brachytherapy (ICBT) and external beam radiotherapy (EBRT).

Methods: Forty endometrial cancer patients staged Ib - IVa by the standard of Federation of International Gynecologic Organization (FIGO), who had not received any treatment were enrolled in this study. Treatment schedules were: (252)Cf ICBT, 10 - 13 Gy(i)/fraction per week, the total dose to point A and point F 35 - 45 Gy(i) and 38 - 50 Gy(i) respectively in 4 fractions. Read More

Undersea Hyperb Med 2007 Sep-Oct;34(5):329-34

Center for Hyperbaric Medicine, Section of Pulmonary and Critical Care Medicine, Virginia Mason Medical Center Seattle, Washington, USA.

Background: Soft tissue radiation necrosis (STRN) is effectively treated with hyperbaric oxygen (HBO,), believed to result from stimulation ofangiogenesis in radiation-injured tissue. Thirty to forty HBO2 treatments are usually recommended for STRN. For various reasons, different hyperbaric facilities offer these treatments once or twice daily and from 5-7 days weekly. Read More

Gastrointest Endosc 2007 Sep;66(3):599; discussion 599

Department of Gastroenterology, Hillel Yaffe Medical Center, Hadera & Bruce Rapaport Faculty of Medicine, The Technion, Hadera, Israel.

Clin Colon Rectal Surg 2007 Feb;20(1):64-72

Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin 53792-7375, USA.

Radiation therapy is commonly utilized as a major component in the treatment of pelvic malignancy. Unfortunately, secondary toxicity to the lower gastrointestinal tract can occur. This most commonly affects the rectum, although injuries to the colon and small intestine are not uncommon. Read More

Strahlenther Onkol 2005 Sep;181(9):606-14

Department of Radiotherapy and Radiation Oncology, University of Goettingen, Germany.

Background And Purpose: Chronic radiation proctitis/enteritis is a relevant complication of pelvic irradiation, which is still mainly treated by supportive measures only. There is some evidence that the combined treatment with pentoxifylline and tocopherol might alter the pathogenesis of radiation-induced fibrosis. In a retrospective analysis the clinical benefit of the treatment with pentoxifylline/tocopherol on radiation-induced proctitis/enteritis was evaluated, compared to supportive care only. Read More

World J Surg 2005 Apr;29(4):459-63

Department of Surgery & Surgical Basic Science, Kyoto University, 54 Shogoin Kawara cho, Sakyo ku, Kyoto 606-8507, Japan.

Although radiation enteritis is a well-recognized sequel of therapeutic irradiation, the standard surgical method is not universally agreed upon. Not only the short-term effect but also the long-term effect after a surgical intervention has been fairly well reported. To reassess the surgical therapy for radiation enteritis, we retrospectively analyzed 48 patients (5 males and 43 females, mean age 58. Read More

Int J Radiat Oncol Biol Phys 2003 Apr;55(5):1254-64

Department of Clinical Oncology, Tuen Mun Hospital, (Special Administrative Region), Hong Kong, People's Republic of China.

Purpose: To review the treatment results and complications of high-dose-rate (HDR) intracavitary brachytherapy for patients with carcinoma of the cervix in a single institute and to compare them with those of low-dose-rate (LDR) brachytherapy reported in the literature.

Methods And Materials: Two hundred twenty patients with carcinoma of the cervix were treated by primary radiotherapy between 1991 and 1998. The median age was 63 (range 24-84). Read More

Semin Oncol 2002 Dec;29(6 Suppl 19):29-33

Department of Radiation Oncology, and the Divisions of Colorectal Surgery and Medical Oncology, Washington University School of Medicine, St Louis, MO 63110-1001, USA.

To improve the resectability and long-term local control of locally advanced rectal cancer, we have initiated a radiation dose-escalation trial. It is hoped that the radioprotector amifostine will sufficiently reduce rectal morbidity (without also reducing tumor response) to permit increasing radiation doses. Only 6 patients have been treated at the first dose level (45 Gy with a 9-Gy boost and concurrent continuous infusion of 5-fluorouracil). Read More

Vopr Onkol 1999 ;45(3):272-8

Research Institute of Oncology, Ministry of Health of the RF, St. Petersburg.

The data on 132 patients with metastases of endometrial carcinoma into the vagina (MECV) were analysed. They had received complex (remote + contact) and contact radiotherapy alone with low-, medium- and high dosage. The following radiobiological models were employed to assess tissue response: time-dose-fractionation factor (TDFF), cumulative radiation effect (CRE) and linear-quadratic dose effect equation (LQDE) ("extrapolated dose of response"). Read More

Int J Radiat Oncol Biol Phys 1999 Mar;43(4):817-25

Division of Gastroenterologic and General Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.

Objective: To assess the frequency and clinical features of treatment-induced bowel injury in rectal carcinoma patients receiving perioperative external beam radiotherapy (EBRT). The frequency of and factors associated with treatment-induced intestinal injury have previously not been well quantified for rectal cancer patients. Postoperative adjuvant chemoirradiation is recommended for Stage II and III rectal cancers, making such data of significant interest. Read More

Plast Reconstr Surg 1999 Feb;103(2):746-7

Ann Acad Med Singapore 1998 Sep;27(5):627-30

Department of Colorectal Surgery, Singapore General Hospital, Singapore.

Bowel injury from radiation given for carcinoma of the cervix is a complex management problem. Prospectively collected computerized data from April 1989 to June 1997 (8 years) were analysed. There were 84 women with a mean age of 60. Read More

Scand J Gastroenterol Suppl 1997 ;222:53-7

Dept. of Medicine, University of Würzburg, Germany.

Selected inflammatory conditions of the distal alimentary tract may respond to topical SCFA treatment. The rationale for using SCFA enemas is based on Roediger's (1980) observation that butyrate is the preferred fuel of colonocytes and that SCFA deficiency could lead, in the short term, to mucosal hypoplasia and, in the long term, to colitis. The absence of luminal nutrients is especially evident in the excluded rectum after complete diversion of the faecal stream. Read More

Strahlenther Onkol 1996 Feb;172(2):53-63

Abteilung für Strahlentherapie, Radiologische Universitätsklinik, Tübingen.

Purpose: Radiotherapy, especially in the abdominal region, is frequently associated with gastrointestinal side effects.

Methods: The article reviews the current knowledge about pathophysiological background, clinical symptoms and the treatment strategies of the major gastrointestinal side effects.

Results: Several basics are investigated and depending on this knowledge some special treatment strategies have been developed (5-HT3-receptor-antagonists in the treatment of nausea, Figure 1, Table 2). Read More

Gynecol Oncol 1996 Jan;60(1):64-71

Department of OBstetrics and Gynecology, Saint Barnabas Medical Center, Livingston, New Jersey 07039, USA.

Forty patients with locally advanced cervical carcinoma were entered into a protocol utilizing the bolus administration of both mitomycin C (10 or 15 mg) on Day 1 and 5-fluorouracil (400 mg) on Day 1-5 followed by sequential pelvic irradiation on Day 6 between September 1980 and October 1985. All patients had poor-prognosis FIGO stage IB, IIB, IIIB, or IVA disease. Only patients with poor prognosis factors such as bulky tumor masses of 5 cm or greater noted on the initial physical exam (37 patients) or poorly differentiated histology (3 patients) were eligible for this study. Read More

Rev Med Chil 1995 Aug;123(8):991-6

Departamento de Cirugía, Hospital San Borja Arriarán, Santiago de Chile.

One hundred forty patients treated for intestinal complications of pelvic irradiation are presented. The most common clinical expression was radiation rectitis, complicated with rectovaginal fistulas in 58% of cases. These patients were subjected to Parks procedure for fistula repair with satisfactory results. Read More

Int J Radiat Oncol Biol Phys 1994 Jun;29(3):529-34

Gershenson Radiation Oncology Center, Wayne State University, Detroit, MI 48201.

Purpose: To evaluate the feasibility and toxicity of 252Cf neutron brachytherapy combined with hyperaccelerated chemoradiotherapy for Stage III and IV cervical cancers.

Methods And Materials: Eleven patients with advanced Stage IIIB-IVA cervical cancers were treated with 252Cf neutron brachytherapy in an up-front schedule followed by cisplatin (CDDP; 50 mg/m2) chemotherapy and hyperfractionated accelerated (1.2 Gy bid) radiotherapy given concurrently with intravenous infusion of 5-Fluorouracil (5-FU) (1000 mg/m2/day x 4 days) in weeks 1 and 4 with conventional radiation (weeks 2, 3, 5, and 6). Read More

Int J Radiat Oncol Biol Phys 1994 Mar;28(4):811-9

Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63108.

Purpose: The impact of some technical factors on morbidity was analyzed in 738 patients with histologically confirmed carcinoma of the prostate treated with definitive irradiation.

Methods And Materials: The records of all patients were reviewed, and morbidity of irradiation was evaluated according to severity. All patients were followed up for a minimum of 3 years (median observation, 6. Read More

Clin Plast Surg 1993 Jul;20(3):573-80

Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia.

Radiation therapy is administered to approximately one third of patients with cancer as part of their treatment plan. Radiation-induced bowel injury is a major cause of morbidity in these patients. The pathophysiology of this condition as well as recommendations for the management of acute and chronic radiation enteritis are discussed. Read More

Dis Colon Rectum 1992 Dec;35(12):1157-60

Outpatients Department of Surgical Oncology, Landeskrankenhaus, Graz, Austria.

Adjuvant radiotherapy (RT) in adenocarcinoma of the rectum requires the application of between 5,500 and 6,600 cGy, while the small bowel does not tolerate doses beyond 4,200 cGy without developing enteritis, often followed by stenosis, fistulas, or perforation. This has spurred several attempts to form an artificial diaphragm between the abdominal cavity and the true pelvis, but they were all burdened with various sequelae. Thus, we developed a simple technique to retain the small bowel out of the RT target volume. Read More

Rev Med Chil 1990 Dec;118(12):1338-43

Departamento de Gastroenterología, Escuela de Medicina, Universidad Católica de Chile, Santiago.

We reviewed the results of surgical therapy for radiation enteropathy in 18 consecutive patients. Fifteen (83%) were females and the age ranged from 31 to 81 years old. The indication for radiotherapy was cancer of the cervix in 10 patients (56). Read More

Strahlenther Onkol 1990 Jan;166(1):95-8

Tumor Center Heidelberg/Mannheim, FRG.

26 patients with unresectable locally recurrent adenocarcinoma of the rectum were treated with a mixed beam schedule. 40 Gy photons were delivered to the whole pelvis followed by a neutron boost of 6.6 or 10 Gy. Read More

World J Surg 1986 Apr;10(2):259-68

Chirurg 1986 Mar;57(3):143-9

Fifty-six operations for intestinal complications of radiation therapy were performed in 48 patients at the Second Surgical Clinic, University of Vienna between 1971 and 1985. The lesions were located in the small bowel (n = 32), the colon and rectum (n = 27) and the duodenum (n = 2). The incidence of the operations increased during the fifteen-years-period, 48. Read More

Fortschr Med 1980 May;98(19):736-9

Every effective tumor therapy is, to a certain extent, accompanied by side effects and this applies also to radiotherapy. A large number of side effects occuring during radiotherapeutic treatment is reversible. The chronic radiation injuries remain, in general, asymptomatic. Read More

Int J Radiat Oncol Biol Phys 1979 Aug;5(8):1275-9

Am J Surg 1979 Apr;137(4):433-42

A review of forty cases of radiation-induced gastrointestinal injuries is presented. Based on this experience and reports in the literature, preoperative management and operative technics are discussed. The increased risk of radiation bowel injury is recognized in patients who have had previous operations. Read More

Int Surg 1977 Jun-Jul;62(6-7):334-7