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Radiation damage to the gastrointestinal tract: mechanisms, diagnosis, and management

Hauer-Jensen, Martina; Wang, Junrub; Boerma, Marjanc; Fu, Qiangd; Denham, James We

Current Opinion in Supportive and Palliative Care: April 2007 - Volume 1 - Issue 1 - p 23–29
doi: 10.1097/SPC.0b013e3281108014
Gastrointestinal symptoms

Purpose of review To summarize current knowledge about gastrointestinal radiation toxicity, with emphasis on mechanisms and clinical diagnosis and management.

Recent findings While there has been only modest change in cancer incidence and cancer mortality rates during the past 30 years, the number of cancer survivors has more than doubled. Moreover, the recognition of uncomplicated cancer cure as the ultimate goal in oncology has intensified efforts to prevent, diagnose, and manage side effects of radiation therapy. These efforts have been facilitated by recent insight into the underlying pathophysiology.

Summary The risk of injury to the intestine is dose limiting during abdominal and pelvic radiation therapy. Delayed bowel toxicity is difficult to manage and adversely impacts the quality of life of cancer survivors. More than 200 000 patients per year receive abdominal or pelvic radiation therapy, and the estimated number of cancer survivors with postradiation intestinal dysfunction is 1.5–2 million. Worthwhile progress towards reducing toxicity of radiation therapy has been made by dose-sculpting treatment techniques. Approaches derived from an improved understanding of the pathophysiology of bowel injury, however, will result in further advances. This article discusses the mechanisms of radiation-induced bowel toxicity and reviews current principles in diagnosis and management.

aDepartments of Surgery and Pathology, University of Arkansas for Medical Sciences and Surgery Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA

bDepartment of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

cDepartment of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

dDepartment of Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

eDepartment of Radiation Oncology, University of Newcastle, Newcastle, New South Wales, Australia

Correspondence to Martin Hauer-Jensen MD, PhD, Arkansas Cancer Research Center, 4301 West Markham, Slot 725, Little Rock, AR 72205, USA Tel: +1 501 686 7912; fax: +1 501 421 0022; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.