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Enteritis

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Acute Side Effects of Radiation Therapy

Abstract

Acute gastrointestinal complications occur in 80% of patients in pelvic radiation therapy [1]. The small intestine appears to be more sensitive to radiation than the colon and rectum [2] and is also more frequently exposed incidentally to radiation during treatment of adjacent organs because of its situation within the peritoneal cavity.

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References

  1. Andreyev J (2005) Gastrointestinal complications of pelvic radiotherapy: are they of any importance? Gut 54(8):1051–1054

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Carr KE (2001) Effects of radiation damage on intestinal morphology. Int Rev Cytol 208:1–119

    Article  CAS  PubMed  Google Scholar 

  3. Nout RA, Putter H, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, van der Steen-Banasik EM et al (2009) Quality of life after pelvic radiotherapy or vaginal brachytherapy for endometrial cancer: first results of the randomized PORTEC-2 trial. J Clin Oncol 27(21):3547–3556

    Article  PubMed  Google Scholar 

  4. Khalid U, McGough C, Hackett C, Blake P, Harrington KJ, Khoo VS et al (2006) A modified inflammatory bowel disease questionnaire and the Vaizey Incontinence questionnaire are more sensitive measures of acute gastrointestinal toxicity during pelvic radiotherapy than RTOG grading. Int J Radiat Oncol Biol Phys 64(5):1432–1441

    Article  PubMed  Google Scholar 

  5. Wedlake L, Thomas K, McGough C, Andreyev H (2008) Small bowel bacterial overgrowth and lactose intolerance during radical pelvic radiotherapy: an observational study. Eur J Cancer 44(15):2212–2217

    Article  CAS  PubMed  Google Scholar 

  6. Berthrong M, Fajardo LF (1981) Radiation injury in surgical pathology: Part II. Alimentary tract. Am J Surg Pathol 5(2):153–178

    Article  CAS  PubMed  Google Scholar 

  7. Otterson MF, Sarna SK, Moulder JE (1988) Effects of fractionated doses of ionizing radiation on small intestinal motor activity. Gastroenterology 95(5):1249–1257

    Article  CAS  PubMed  Google Scholar 

  8. Summers R, Kent TH, Osborne J (1970) Effects of drugs, ileal obstruction, and irradiation on rat gastrointestinal propulsion. University of Iowa, Iowa City

    Google Scholar 

  9. Kavanagh BD, Pan CC, Dawson LA, Das SK, Li XA, Ten Haken RK et al (2010) Radiation dose-volume effects in the stomach and small bowel. Int J Radiat Oncol Biol Phys 76(3):S101–S1S7

    Article  PubMed  Google Scholar 

  10. Stacey R, Green JT (2014) Radiation-induced small bowel disease: latest developments and clinical guidance. Ther Adv Chronic Dis 5(1):15–29

    Article  PubMed  PubMed Central  Google Scholar 

  11. Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis CC, De Winter KA, Lutgens LC, van den Bergh AC, van der Steen-Banasik E, Beerman H, van Lent M, PORTEC Study Group, The Postoperative Radiation Therapy in Endometrial Carcinoma (2001) The morbidity of treatment for patients with Stage I endometrial cancer: results from a randomized trial. Int J Radiat Oncol Biol Phys 51(5):1246–1255

    Article  CAS  PubMed  Google Scholar 

  12. Newman A, Blendis L, Katsaris J, Charlesworth M, Walter L (1973) Small-intestinal injury in women who have had pelvic radiotherapy. Lancet 302(7844):1471–1473

    Article  Google Scholar 

  13. Yeoh E, Horowitz M, Russo A, Muecke T, Robb T, Maddox A et al (1993) Effect of pelvic irradiation on gastrointestinal function: a prospective longitudinal study. Am J Med 95(4):397–406

    Article  CAS  PubMed  Google Scholar 

  14. Minsky BD, Conti JA, Huang Y, Knopf K (1995) Relationship of acute gastrointestinal toxicity and the volume of irradiated small bowel in patients receiving combined modality therapy for rectal cancer. J Clin Oncol 13(6):1409–1416

    Article  CAS  PubMed  Google Scholar 

  15. Roeske JC, Bonta D, Mell LK, Lujan AE, Mundt AJ (2003) A dosimetric analysis of acute gastrointestinal toxicity in women receiving intensity-modulated whole-pelvic radiation therapy. Radiother Oncol 69(2):201–207

    Article  PubMed  Google Scholar 

  16. Keys HM, Bundy BN, Stehman FB, Muderspach LI, Chafe WE, Suggs CL et al (1999) Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 340(15):1154–1161

    Article  CAS  PubMed  Google Scholar 

  17. Morris M, Eifel PJ, Lu J, Grigsby PW, Levenback C, Stevens RE et al (1999) Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med 340(15):1137–1143

    Article  CAS  PubMed  Google Scholar 

  18. Kirwan JM, Symonds P, Green JA, Tierney J, Collingwood M, Williams CJ (2003) A systematic review of acute and late toxicity of concomitant chemoradiation for cervical cancer. Radiother Oncol 68(3):217–226

    Article  PubMed  Google Scholar 

  19. Willett CG, Ooi C-J, Zietman AL, Menon V, Goldberg S, Sands BE et al (2000) Acute and late toxicity of patients with inflammatory bowel disease undergoing irradiation for abdominal and pelvic neoplasms. Int J Radiat Oncol Biol Phys 46(4):995–998

    Article  CAS  PubMed  Google Scholar 

  20. Gallagher MJ, Brereton HD, Rostock RA, Zero JM, Zekoski DA, Poyss LF et al (1986) A prospective study of treatment techniques to minimize the volume of pelvic small bowel with reduction of acute and late effects associated with pelvic irradiation. Int J Radiat Oncol Biol Phys 12(9):1565–1573

    Article  CAS  PubMed  Google Scholar 

  21. Huang E-Y, Sung C-C, Ko S-F, Wang C-J, Yang KD (2007) The different volume effects of small-bowel toxicity during pelvic irradiation between gynecologic patients with and without abdominal surgery: a prospective study with computed tomography-based dosimetry. Int J Radiat Oncol Biol Phys 69(3):732–739

    Article  PubMed  Google Scholar 

  22. Rödel C, Fietkau R, Keilholz L, Grabenbauer G, Kessler H, Martus P et al (1997) The acute toxicity of the simultaneous radiochemotherapy of rectal carcinoma. Strahlenther Onkol 173(8):415–421

    Article  PubMed  Google Scholar 

  23. Schofield PF, Holden D, Carr N (1983) Bowel disease after radiotherapy. J R Soc Med 76(6):463–466

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the radiation therapy oncology group (RTOG) and the European organization for research and treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys 31(5):1341–1346

    Article  CAS  PubMed  Google Scholar 

  25. NCI, NIH, DHHS (2009) Common terminology criteria for adverse events v4.0. National Cancer Institute, Bethesda, MD

    Google Scholar 

  26. Gunderson LL, Russell AH, Llewellyn HJ, Doppke KP, Tepper JE (1985) Treatment planning for colorectal cancer: radiation and surgical techniques and value of small-bowel films. Int J Radiat Oncol Biol Phys 11(7):1379–1393

    Article  CAS  PubMed  Google Scholar 

  27. Green N (1983) The avoidance of small intestine injury in gynecologic cancer. Int J Radiat Oncol Biol Phys 9(9):1385–1390

    Article  CAS  PubMed  Google Scholar 

  28. Acker JC, Marks LB (1995) The lack of impact of pelvic irradiation on small bowel mobility: implications for radiotherapy treatment planning. Int J Radiat Oncol Biol Phys 32(5):1473–1475

    Article  CAS  PubMed  Google Scholar 

  29. Adli M, Mayr NA, Kaiser HS, Skwarchuk MW, Meeks SL, Mardirossian G et al (2003) Does prone positioning reduce small bowel dose in pelvic radiation with intensity-modulated radiotherapy for gynecologic cancer? Int J Radiat Oncol Biol Phys 57(1):230–238

    Article  PubMed  Google Scholar 

  30. Martin J, Fitzpatrick K, Horan G, McCloy R, Buckney S, O’Neill L et al (2005) Treatment with a belly-board device significantly reduces the volume of small bowel irradiated and results in low acute toxicity in adjuvant radiotherapy for gynecologic cancer: results of a prospective study. Radiother Oncol 74(3):267–274

    Article  PubMed  Google Scholar 

  31. Urbano MTG, Henrys AJ, Adams EJ, Norman AR, Bedford JL, Harrington KJ et al (2006) Intensity-modulated radiotherapy in patients with locally advanced rectal cancer reduces volume of bowel treated to high dose levels. Int J Radiat Oncol Biol Phys 65(3):907–916

    Article  Google Scholar 

  32. Kachnic LA (2007) Adjuvant chemoradiation for localized rectal cancer: current trends and future directions. Gastrointest Cancer Res 1(4 Suppl 2):S64–S72

    PubMed  PubMed Central  Google Scholar 

  33. Mundt AJ, Roeske JC, Lujan AE, Yamada SD, Waggoner SE, Fleming G et al (2001) Initial clinical experience with intensity-modulated whole-pelvis radiation therapy in women with gynecologic malignancies. Gynecol Oncol 82(3):456–463

    Article  CAS  PubMed  Google Scholar 

  34. Mundt AJ, Lujan AE, Rotmensch J, Waggoner SE, Yamada SD, Fleming G et al (2002) Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys 52(5):1330–1337

    Article  PubMed  Google Scholar 

  35. Nguyen B, Hamper U (1997) Pelvic silicone prosthesis for prevention of radiation enteritis: US and CT features. Abdom Imaging 22(2):175–177

    Article  CAS  PubMed  Google Scholar 

  36. Dasmahapatra KS, Swaminathan AP (1991) The use of a biodegradable mesh to prevent radiation-associated small-bowel injury. Arch Surg 126(3):366–369

    Article  CAS  PubMed  Google Scholar 

  37. Choi HJ, Lee HS (1995) Effect of omental pedicle hammock in protection against radiation-induced enteropathy in patients with rectal cancer. Dis Colon Rectum 38(3):276–280

    Article  CAS  PubMed  Google Scholar 

  38. Shukla P, Gupta D, Bisht SS, Pant MC, Bhatt ML, Gupta R et al (2010) Circadian variation in radiation-induced intestinal mucositis in patients with cervical carcinoma. Cancer 116(8):2031–2035

    Article  PubMed  Google Scholar 

  39. Athanassiou H, Antonadou D, Coliarakis N, Kouveli A, Synodinou M, Paraskevaidis M et al (2003) Protective effect of amifostine during fractionated radiotherapy in patients with pelvic carcinomas: results of a randomized trial. Int J Radiat Oncol Biol Phys 56(4):1154–1160

    Article  CAS  PubMed  Google Scholar 

  40. Empey LR, Papp JD, Jewell LD, Fedorak RN (1992) Mucosal protective effects of vitamin E and misoprostol during acute radiation-induced enteritis in rats. Dig Dis Sci 37(2):205–214

    Article  CAS  PubMed  Google Scholar 

  41. Wedlake LJ, Silia F, Benton B, Lalji A, Thomas K, Dearnaley DP et al (2012) Evaluating the efficacy of statins and ACE-inhibitors in reducing gastrointestinal toxicity in patients receiving radiotherapy for pelvic malignancies. Eur J Cancer 48(14):2117–2124

    Article  CAS  PubMed  Google Scholar 

  42. Wedlake L, Shaw C, Whelan K, Andreyev H (2013) Systematic review: the efficacy of nutritional interventions to counteract acute gastrointestinal toxicity during therapeutic pelvic radiotherapy. Aliment Pharmacol Ther 37(11):1046–1056

    Article  CAS  PubMed  Google Scholar 

  43. Klimberg VS, Souba WW, Dolson DJ, Salloum RM, Hautamaki RD, Plumley DA et al (1990) Prophylactic glutamine protects the intestinal mucosa from radiation injury. Cancer 66(1):62–68

    Article  CAS  PubMed  Google Scholar 

  44. Vidal-Casariego A, Calleja-Fernández A, Cano-Rodríguez I, Cordido F, Ballesteros-Pomar MD (2015) Effects of oral glutamine during abdominal radiotherapy on chronic radiation enteritis: a randomized controlled trial. Nutrition 31(1):200–204

    Article  CAS  PubMed  Google Scholar 

  45. Conejo IM, Castillejo AR, de Dios NR, Arnalot PF, Latiesas JS, Galán JL et al (2011) Prevention of acute radiation enteritis: efficacy and tolerance of glutamine. Clin Transl Oncol 13(10):760–763

    Article  Google Scholar 

  46. Vidal-Casariego A, Calleja-Fernández A, de Urbina-González JJO, Cano-Rodríguez I, Cordido F, Ballesteros-Pomar MD (2014) Efficacy of glutamine in the prevention of acute radiation enteritis: a randomized controlled trial. J Parenter Enteral Nutr 38(2):205–213

    Article  Google Scholar 

  47. Rao R, Samak G (2012) Role of glutamine in protection of intestinal epithelial tight junctions. J Epithel Biol Pharmacol 5(Suppl 1-M7):47–54

    CAS  PubMed  Google Scholar 

  48. Vazquez I, Gomez-De-Segura IA, Grande AG, Escribano A, Gonzalez-Gancedo P, Gomez A et al (1999) Protective effect of enriched diet plus growth hormone administration on radiation-induced intestinal injury and on its evolutionary pattern in the rat. Dig Dis Sci 44(11):2350–2358

    Article  CAS  PubMed  Google Scholar 

  49. Wilkins HR, Ohneda K, Keku TO, D’Ercole AJ, Fuller CR, Williams KL et al (2002) Reduction of spontaneous and irradiation-induced apoptosis in small intestine of IGF-I transgenic mice. Am J Physiol Gastrointest Liver Physiol 283(2):G457–G464

    Article  CAS  PubMed  Google Scholar 

  50. Mylonas PG, Matsouka PT, Papandoniou EV, Vagianos C, Kalfarentzos F, Alexandrides TK (2000) Growth hormone and insulin-like growth factor I protect intestinal cells from radiation induced apoptosis. Mol Cell Endocrinol 160(1):115–122

    Article  CAS  PubMed  Google Scholar 

  51. Howarth G, Fraser R, Frisby C, Schirmer M, Yeoh E (1997) Effects of insulin-like growth factor-I administration on radiation enteritis in rats. Scand J Gastroenterol 32(11):1118–1124

    Article  CAS  PubMed  Google Scholar 

  52. Boerma M, Wang J, Burnett AF, Santin AD, Roman JJ, Hauer-Jensen M (2007) Local administration of interleukin-11 ameliorates intestinal radiation injury in rats. Cancer Res 67(19):9501–9506

    Article  CAS  PubMed  Google Scholar 

  53. Booth C, Booth D, Williamson S, Demchyshyn L, Potten CS (2004) Teduglutide ([Gly2] GLP-2) protects small intestinal stem cells from radiation damage. Cell Prolif 37(6):385–400

    Article  CAS  PubMed  Google Scholar 

  54. Khan WB, Shui C, Ning S, Knox SJ (1997) Enhancement of murine intestinal stem cell survival after irradiation by keratinocyte growth factor. Radiat Res 148(3):248–253

    Article  CAS  PubMed  Google Scholar 

  55. Matthews MA, Watkins D, Darbyshire A, Carson WE, Besner GE (2013) Heparin-binding EGF-like growth factor (HB-EGF) protects the intestines from radiation therapy-induced intestinal injury. J Pediatr Surg 48(6):1316–1322

    Article  PubMed  PubMed Central  Google Scholar 

  56. Ijiri K, Potten C (1990) The circadian rhythm for the number and sensitivity of radiation-induced apoptosis in the crypts of mouse small intestine. Int J Radiat Biol 58(1):165–175

    Article  CAS  PubMed  Google Scholar 

  57. Ijiri K, Potten CS (1988) Circadian rhythms in the incidence of apoptotic cells and number of clonogenic cells in intestinal crypts after radiation using normal and reversed light conditions. Int J Radiat Biol 53(5):717–727

    Article  CAS  Google Scholar 

  58. Lawrence TS, Rosenberg SA (2015) DeVita, Hellman, and Rosenberg’s cancer: principles & practice of oncology. Lippincott Williams & Wilkins, Philadelphia, PA

    Google Scholar 

  59. Halperin EC, Brady LW, Wazer DE, Perez CA (2013) Perez & Brady’s principles and practice of radiation oncology. Lippincott Williams & Wilkins, Philadelphia, PA

    Google Scholar 

  60. Yavuz MN, Yavuz AA, Aydin F, Can G, Kavgaci H (2002) The efficacy of octreotide in the therapy of acute radiation-induced diarrhea: a randomized controlled study. Int J Radiat Oncol Biol Phys 54(1):195–202

    Article  CAS  PubMed  Google Scholar 

  61. Loperamide—Medscape Reference. http://reference.medscape.com/drug/imodium-k-pek-ii-loperamide-342041

  62. Heusinkveld RS, Manning MR, Aristizabal SA (1978) Control of radiation-induced diarrhea with cholestyramine. Int J Radiat Oncol Biol Phys 4(7):687–690

    Article  CAS  PubMed  Google Scholar 

  63. Condon JR, Wolverson RL, South M, Brinkley D (1978) Radiation diarrhoea and cholestyramine. Postgrad Med J 54(638):838–839

    Article  PubMed Central  Google Scholar 

  64. Mennie A, Dalley V (1973) Aspirin in radiation-induced diarrhoea. Lancet 301(7812):1131

    Article  Google Scholar 

  65. Mennie A, Dalley V, Dinneen L, Collier H (1975) Treatment of radiation-induced gastrointestinal distress with acetylsalicylate. Lancet 306(7942):942–943

    Article  Google Scholar 

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Sourati, A., Ameri, A., Malekzadeh, M. (2017). Enteritis. In: Acute Side Effects of Radiation Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-55950-6_15

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  • DOI: https://doi.org/10.1007/978-3-319-55950-6_15

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