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Gastrointestinal toxicity associated to radiation therapy

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Abstract

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. The possible relationship between these parameters and clinical, anatomical and, more recently, genetic factors has to be considered. Treatment options include initial conservative medical therapies, endoscopic procedures, hyperbaric oxygen and surgery. Some pharmacological agents to prevent gastrointestinal toxicity are under investigation.

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References

  1. Andreyev HJ (2007) Gastrointestinal Problems after Pelvic Radiotherapy: the past, the present and the future. Clinical Oncology 19:790–799

    Article  CAS  PubMed  Google Scholar 

  2. Phan J, Swanson D, Levy L et al (2009) Late rectal complications after Brachytherapy for localized Prostate Cancer. Cancer 1:1827–1839

    Article  Google Scholar 

  3. Werner-Wasik M (2005) Treatment-Related Esophagitis. Seminars in Oncology 32(Suppl 3): 60–66

    Article  Google Scholar 

  4. Phillips T, Ross G (1974) Time-dose relationships in the mouse esophagus. Radiology 113:435

    CAS  PubMed  Google Scholar 

  5. O’Rourke I, Tiver K, Bull C (1988) Swallowing performance after radiation therapy for carcinoma of the esophagus. Cancer 61:2022

    Article  PubMed  Google Scholar 

  6. Turrisi AT, III, Kim K, Blum R et al (1999) Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med 340:265–271

    Article  CAS  PubMed  Google Scholar 

  7. Byhardt RW, Scott C, Sause WT et al (1998) Response, toxicity, failure patterns, and survival in five Radiation Therapy Oncology Group (RTOG. trials of sequential and/or concurrent chemotherapy and radiotherapy for locally advanced non-small-cell carcinoma of the lung. Int J Radiat Oncol Biol Phys 42:469–478

    CAS  PubMed  Google Scholar 

  8. Bradley J, Movsas B (2004) Radiation esophagitis: Predictive factors and preventive strategies. Semin Radiat Oncol 14:280–286

    Article  PubMed  Google Scholar 

  9. Rose J, Rodrigues G, Yaremko B et al (2009) Systematic review of dose-volume parameters in the prediction of esophagitis in thoracic radiotherapy. Radiother Oncol 91:282–287

    Article  PubMed  Google Scholar 

  10. Rodriguez N, Algara M, Foro P et al (2009) Predictors of acute esophagitis in lung cancer patients treated with concurrent three-dimensional conformal radiotherapy and chemotherapy. Int J Radiat Oncol Biol Phys 73:810–817

    PubMed  Google Scholar 

  11. Watkins JM, Wahlquist AE, Shirai K et al (2009) Factors associated with severe acute esophagitis from hyperfractionated radiotherapy with concurrent chemotherapy for limited-stage small-cell lung cancer. Int J Radiat Oncol Biol Phys 74:1108–1113

    PubMed  Google Scholar 

  12. Singh AK, Lockett MA, Bradley JD (2003) Predictors of radiation-induced esophageal toxicity in patients with non-small-cell lung cancer treated with three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 55:337–341

    PubMed  Google Scholar 

  13. Ahn SJ, Kahn D, Zhou S et al (2005) Dosimetric and clinical predictors for radiation-induced esophageal injury. Int J Radiat Oncol Biol Phys 61:335–347

    PubMed  Google Scholar 

  14. Kim TH, Cho KH, Pyo HR et al (2005) Dose-volumetric parameters of acute esophageal toxicity in patients with lung cancer treated with three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 62:995–1002

    Article  PubMed  CAS  Google Scholar 

  15. Wei X, Liu HH, Tucker SL et al (2006) Risk factors for acute esophagitis in non-small-cell lung cancer patients treated with concurrent chemotherapy and three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 66:100–107

    PubMed  Google Scholar 

  16. Takeda K, Nemoto K, Saito H et al (2006) Predictive factors for acute esophageal toxicity in thoracic radiotherapy. Tohoku J Exp Med 208:299–306

    Article  PubMed  Google Scholar 

  17. Sasso FS, Sasso G, Marsiglia HR et al (2001) Pharmacological and dietary prophylaxis and treatment of acute actinic esophagitis during mediastinal radiotherapy. Dig Dis Sci 46:746–749

    Article  CAS  PubMed  Google Scholar 

  18. McGinnis WL, Loprinzi CL, Buskirk SJ et al (1997) Placebo-controlled trial of sucralfate for inhibiting radiation-induced esophagitis. J Clin Oncol 15:1239–1243

    CAS  PubMed  Google Scholar 

  19. Keefe DM (2007) Intestinal mucositis: mechanisms and management. Curr Opin Oncol 19:323–327

    Article  PubMed  Google Scholar 

  20. Weiss JF, Landauer MR (2009) History and development of radiation-protective agents. Int J Radiat Biol 85:539–573

    Article  CAS  PubMed  Google Scholar 

  21. Movsas B, Scott C, Langer C et al (2005) Randomized trial of amifostine in locally advanced non-small-cell lung cancer patients receiving chemotherapy and hyperfractionated radiation: radiation therapy oncology group trial 98-01. J Clin Oncol 23:2145–2154

    Article  CAS  PubMed  Google Scholar 

  22. Sasse AD, Clark LG, Sasse EC et al (2006) Amifostine reduces side effects and improves complete response rate during radiotherapy: results of a metaanalysis. Int J Radiat Oncol Biol Phys 64:784–791

    CAS  PubMed  Google Scholar 

  23. Hensley ML, Hagerty KL, Kewalramani T et al (2009) American Society of Clinical Oncology 2008 clinical practice guideline update: use of chemotherapy and radiation therapy protectants. J Clin Oncol 27:127–145

    Article  CAS  PubMed  Google Scholar 

  24. Huang EY, Lin H, Hsu HC et al (2000) High external parametrial dose can increase the probability of radiation proctitis in patients with uterine cervix cancer. Gynecol Oncol 79:406–410

    Article  CAS  PubMed  Google Scholar 

  25. Algara M, Rodriguez N, Vinals P et al (2007) Prevention of radiochemotherapy-induced esophagitis with glutamine: results of a pilot study. Int J Radiat Oncol Biol Phys 69:342–349

    CAS  PubMed  Google Scholar 

  26. Theis VS, Sripadam R, Ramani V et al (2009) Chronic Radiation Enteritis. Clin Oncol (R Coll Radiol. In press

  27. MacNaughton WK (2000) Review article: new insights into the pathogenesis of radiation-induced intestinal dysfunction. Aliment Pharmacol Ther 14:523–528

    Article  CAS  PubMed  Google Scholar 

  28. Yeoh EK, Horowitz M (1987) Radiation enteritis. Surg Gynecol Obstet 165:373–379

    CAS  PubMed  Google Scholar 

  29. Rodier JF (1995) Radiation enteropathy-incidence, aetiology, risk factors, pathology and symptoms. Tumori 81(3 Suppl):122–125

    CAS  PubMed  Google Scholar 

  30. Pia de la MM, Gotteland M, Ramirez C et al (2001) Acute nutritional and intestinal changes after pelvic radiation. J Am Coll Nutr 20:637–642

    Google Scholar 

  31. Bourgier C, Haydont V, Milliat F et al (2005) Inhibition of Rho kinase modulates radiation induced fibrogenic phenotype in intestinal smooth muscle cells through alteration of the cyto-skeleton and connective tissue growth factor expression. Gut 54:336–343

    Article  CAS  PubMed  Google Scholar 

  32. Haydont V, Mathe D, Bourgier C et al (2005) Induction of CTGF by TGF-beta1 in normal and radiation enteritis human smooth muscle cells: Smad/Rho balance and therapeutic perspectives. Radiother Oncol 76:219–225

    Article  CAS  PubMed  Google Scholar 

  33. Nguyen NP, Antoine JE, Dutta S et al (2002) Current concepts in radiation enteritis and implications for future clinical trials. Cancer 95:1151–1163

    Article  PubMed  Google Scholar 

  34. Classen J, Belka C, Paulsen F et al (1998) Radiation-induced gastrointestinal toxicity. Pathophysiology, approaches to treatment and prophylaxis. Strahlenther Onkol 174(Suppl 3):82–84

    PubMed  Google Scholar 

  35. Kwitko AO, Pieterse AS, Hecker R et al (1982) Chronic radiation injury to the intestine: a clinicopathological study. Aust N Z J Med 12:272–277

    CAS  PubMed  Google Scholar 

  36. Sher ME, Bauer J (1990) Radiation-induced enteropathy. Am J Gastroenterol 85:121–128

    CAS  PubMed  Google Scholar 

  37. Kimura T, Iwagaki H, Hizuta A et al (1995) Colorectal cancer after irradiation for cervical cancer-case reports. Anticancer Res 15:557–558

    CAS  PubMed  Google Scholar 

  38. Kao MS (1995) Intestinal complications of radiotherapy in gynecologic malignancy—clinical presentation and management. Int J Gynaecol Obstet 49(Suppl):S69–S75

    Article  PubMed  Google Scholar 

  39. Letschert JG, Lebesque JV, Aleman BM et al (1994) The volume effect in radiation-related late small bowel complications: results of a clinical study of the EORTC Radiotherapy Cooperative Group in patients treated for rectal carcinoma. Radiother Oncol 32:116–123

    Article  CAS  PubMed  Google Scholar 

  40. Hanks GE, Herring DF, Kramer S (1983) Patterns of care outcome studies. Results of the national practice in cancer of the cervix. Cancer 51:959–967

    Article  CAS  PubMed  Google Scholar 

  41. Czito BG, Willett CG, Bendell JC et al (2006) Increased toxicity with gefitinib, capecitabine, and radiation therapy in pancreatic and rectal cancer: phase I trial results. J Clin Oncol 24:656–662

    Article  CAS  PubMed  Google Scholar 

  42. Ryan DP (2006) Nonsurgical approaches to colorectal cancer. Oncologist 11:999–1002

    Article  PubMed  Google Scholar 

  43. Mohiuddin M, Winter K, Mitchell E et al (2006) Randomized phase II study of neoadjuvant combined-modality chemoradiation for distal rectal cancer: Radiation Therapy Oncology Group Trial 0012. J Clin Oncol 24:650–655

    Article  CAS  PubMed  Google Scholar 

  44. DeCosse JJ, Rhodes RS, Wentz WB et al (1969) The natural history and management of radiation induced injury of the gastrointestinal tract. Ann Surg 170:369–384

    Article  CAS  PubMed  Google Scholar 

  45. Chon BH, Loeffler JS (2002) The effect of nonmalignant systemic disease on tolerance to radiation therapy. Oncologist 7:136–143

    Article  PubMed  Google Scholar 

  46. Song DY, Lawrie WT, Abrams RA et al (2001) Acute and late radiotherapy toxicity in patients with inflammatory bowel disease. Int J Radiat Oncol Biol Phys 51:455–459

    CAS  PubMed  Google Scholar 

  47. Willett CG, Ooi CJ, Zietman AL 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 46:995–998

    CAS  PubMed  Google Scholar 

  48. Lin L, Vargas C, Hsi W et al (2008) Dosimetric uncertainty in prostate cancer proton radiotherapy. Med Phys 35:4800–4807

    Article  PubMed  Google Scholar 

  49. Emami B, Lyman J, Brown A et al (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21:109–122

    CAS  PubMed  Google Scholar 

  50. Roeske JC, Bonta D, Mell LK et al (2003) A dosimetric analysis of acute gastrointestinal toxicity in women receiving intensity-modulated whole-pelvic radiation therapy. Radiother Oncol 69: 201–207

    Article  PubMed  Google Scholar 

  51. Fiorino C, Valdagni R, Rancati T et al (2009) Dose-volume effects for normal tissues in external radiotherapy: pelvis. Radiother Oncol 93:153–167

    Article  PubMed  Google Scholar 

  52. Ghoshal UC, Ghoshal U, Das K et al (2006) Utility of hydrogen breath tests in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome and its relationship with oro-cecal transit time. Indian J Gastroenterol 25:6–10

    PubMed  Google Scholar 

  53. Gasbarrini A, Lauritano EC, Gabrielli M et al (2007) Small intestinal bacterial overgrowth: diagnosis and treatment. Dig Dis 25:237–240

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  55. Loiudice TA, Lang JA (1983) Treatment of radiation enteritis: a comparison study. Am J Gastroenterol 78:481–487

    CAS  PubMed  Google Scholar 

  56. Chiao TB, Lee AJ (2005) Role of pentoxifylline and vitamin E in attenuation of radiation-induced fibrosis. Ann Pharmacother 39:516–522

    Article  CAS  PubMed  Google Scholar 

  57. Dietz DW, Remzi FH, Fazio VW (2001) Strictureplasty for obstructing small-bowel lesions in diffuse radiation enteritis—successful outcome in five patients. Dis Colon Rectum 44:1772–1777

    Article  CAS  PubMed  Google Scholar 

  58. Onodera H, Nagayama S, Mori A et al (2005) Reappraisal of surgical treatment for radiation enteritis. World J Surg 29:459–463

    Article  PubMed  Google Scholar 

  59. Athanassiou H, Antonadou D, Coliarakis N 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 56:1154–1160

    Article  CAS  PubMed  Google Scholar 

  60. Kozelsky TF, Meyers GE, Sloan JA et al (2003) Phase III double-blind study of glutamine versus placebo for the prevention of acute diarrhea in patients receiving pelvic radiation therapy. J Clin Oncol 21:1669–1674

    Article  CAS  PubMed  Google Scholar 

  61. Koelbl O, Richter S, Flentje M (1999) Influence of patient positioning on dose-volume histogram and normal tissue complication probability for small bowel and bladder in patients receiving pelvic irradiation: a prospective study using a 3D planning system and a radiobiological model. Int J Radiat Oncol Biol Phys 45:1193–1198

    Article  CAS  PubMed  Google Scholar 

  62. Allal AS, Bischof S, Nouet P (2002) Impact of the “belly board“ device on treatment reproducibility in preoperative radiotherapy for rectal cancer. Strahlenther Onkol 178:259–262

    Article  PubMed  Google Scholar 

  63. Urbano M, Henrys A, Adams E 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 65:905

    Google Scholar 

  64. Mundt AJ, Mell LK, Roeske JC (2003) Preliminary analysis of chronic gastrointestinal toxicity in gynecology patients treated with intensity-modulated whole pelvic radiation therapy. Int J Radiat Oncol Biol Phys 56:1354–1360

    Article  PubMed  Google Scholar 

  65. Schultheiss TE, Lee WR, Hunt MA et al (1997) Late GI and GU complications in the treatment of prostate cancer. Int J Radiat Oncol Biol Phys 37:3–11

    CAS  PubMed  Google Scholar 

  66. Babb RR (1996) Radiation proctitis: a review. Am J Gastroenterol 91:1309–1311

    CAS  PubMed  Google Scholar 

  67. Gilinsky NH, Burns DG, Barbezat GO et al (1983) The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients. Q J Med 52:40–53

    CAS  PubMed  Google Scholar 

  68. Leiper K, Morris AI (2007) Treatment of radiation proctitis. Clin Oncol (R Coll Radiol 19:724–729

    CAS  Google Scholar 

  69. Haboubi NY, Schofield PF, Rowland PL (1988) The light and electron microscopic features of early and late phase radiation-induced proctitis. Am J Gastroenterol 83:1140–1144

    CAS  PubMed  Google Scholar 

  70. Shepherd NA (1991) Pathological mimics of chronic inflammatory bowel disease. J Clin Pathol 44:726–733

    Article  CAS  PubMed  Google Scholar 

  71. Chrouser KL, Leibovich BC, Sweat SD et al (2005) Urinary fistulas following external radiation or permanent brachytherapy for the treatment of prostate cancer. J Urol 173:1953–1957

    Article  PubMed  Google Scholar 

  72. Syndikus I, Morgan RC, Sydes MR et al (200) Late Gastrointestinal Toxicity after Dose-Escalated Conformal Radiotherapy for Early Prostate Cancer: Results from the UK Medical Research Council RT01 Trial (Isrctn47772397) Int J Radiat Oncol Biol Phys, in press

  73. Matzinger O, Duclos F, van den Juvy BA et al (2009) Acute toxicity of curative radiotherapy for intermediate- and high-risk localised prostate cancer in the EORTC trial 22991. Eur J Cancer 45:2825–2834

    Article  CAS  PubMed  Google Scholar 

  74. Fellin G, Fiorino C, Rancati T et al (2009) Clinical and dosimetric predictors of late rectal toxicity after conformal radiation for localized prostate cancer: results of a large multicenter observational study. Radiother Oncol 93:197–202

    Article  PubMed  Google Scholar 

  75. Peeters ST, Hoogeman MS, Heemsbergen WD et al (2006) Rectal bleeding, fecal incontinence, and high stool frequency after conformal radiotherapy for prostate cancer: normal tissue complication probability modeling. Int J Radiat Oncol Biol Phys 66:11–19

    PubMed  Google Scholar 

  76. Vavassori V, Fiorino C, Rancati T et al (2007) Predictors for rectal and intestinal acute toxicities during prostate cancer high-dose 3D-CRT: results of a prospective multicenter study. Int J Radiat Oncol Biol Phys 67:1401–1410

    PubMed  Google Scholar 

  77. Storey MR, Pollack A, Zagars G et al (2000) Complications from radiotherapy dose escalation in prostate cancer: preliminary results of a randomized trial. Int J Radiat Oncol Biol Phys 48:635–642

    CAS  PubMed  Google Scholar 

  78. Jackson A, Skwarchuk MW, Zelefsky MJ et al (2001) Late rectal bleeding after conformal radiotherapy of prostate cancer. II. Volume effects and dose-volume histograms. Int J Radiat Oncol Biol Phys 49:685–698

    CAS  PubMed  Google Scholar 

  79. Huang EY, Wang CJ, Hsu HC et al (2004) Dosimetric factors predicting severe radiation-induced bowel complications in patients with cervical cancer: combined effect of external parametrial dose and cumulative rectal dose. Gynecol Oncol 95:101–108

    Article  PubMed  Google Scholar 

  80. Fiorino C, Sanguineti G, Cozzarini C et al (2003) Rectal dose-volume constraints in high-dose radiotherapy of localized prostate cancer. Int J Radiat Oncol Biol Phys 57:953–962

    PubMed  Google Scholar 

  81. Michalski JM, Winter K, Purdy JA et al (2004) Toxicity after three-dimensional radiotherapy for prostate cancer with RTOG 9406 dose level IV. Int J Radiat Oncol Biol Phys 58:735–742

    PubMed  Google Scholar 

  82. Vargas C, Martinez A, Kestin LL et al (2005) Dose-volume analysis of predictors for chronic rectal toxicity after treatment of prostate cancer with adaptive image-guided radiotherapy. Int J Radiat Oncol Biol Phys 62:1297–1308

    PubMed  Google Scholar 

  83. Fonteyne V, De NW, Villeirs G (2007) Late radiotherapy-induced lower intestinal toxicity (RILIT. of intensity-modulated radiotherapy for prostate cancer: the need for adapting toxicity scales and the appearance of the sigmoid colon as co-responsible organ for lower intestinal toxicity. Radiother Oncol 84:156–163

    Article  PubMed  Google Scholar 

  84. Fiorino C, Fellin G, Rancati T et al (2008) Clinical and dosimetric predictors of late rectal syndrome after 3D-CRT for localized prostate cancer: preliminary results of a multicenter prospective study. Int J Radiat Oncol Biol Phys 70:1130–1137

    PubMed  Google Scholar 

  85. Kuban DA, Tucker SL, Dong L et al (2008) Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 70:67–74

    PubMed  Google Scholar 

  86. Karlsdottir A, Muren LP, Wentzel-Larsen T et al (2008) Late gastrointestinal morbidity after three-dimensional conformal radiation therapy for prostate cancer fades with time in contrast to genitourinary morbidity. Int J Radiat Oncol Biol Phys 70:1478–1486

    PubMed  Google Scholar 

  87. Valdagni R, Rancati T, Fiorino C (2009) Predictive models of toxicity with external radiotherapy for prostate cancer: clinical issues. Cancer 115(Suppl):3141–3149

    Article  PubMed  Google Scholar 

  88. Spry N, Halkett G, Aoun S et al (2008) Development of a European organization for research and treatment of cancer module to assess the quality of life of patients with proctitis after pelvic radiotherapy for malignancy. Int J Radiat Oncol Biol Phys 72:522–528

    PubMed  Google Scholar 

  89. Damaraju S, Murray D, Dufour J et al (2006) Association of DNA repair and steroid metabolism gene polymorphisms with clinical late toxicity in patients treated with conformal radiotherapy for prostate cancer. Clin Cancer Res 12:2545–2554

    Article  CAS  PubMed  Google Scholar 

  90. Burri RJ, Stock RG, Cesaretti JA et al (2008) Association of single nucleotide polymorphisms in SOD2, XRCC1 and XRCC3 with susceptibility for the development of adverse effects resulting from radiotherapy for prostate cancer. Radiat Res 170:49–59

    Article  CAS  PubMed  Google Scholar 

  91. Baum CA, Bhatia P, Miner PB Jr (1989) Increased colonic mucosal mast cells associated with severe watery diarrhea and microscopic colitis. Dig Dis Sci 34:1462–1465

    Article  CAS  PubMed  Google Scholar 

  92. Goldstein F, Khoury J, Thornton JJ (1976) Treatment of chronic radiation enteritis and colitis with salicylazosulfapyridine and systemic corticosteroids. A pilot study. Am J Gastroenterol 65:201–208

    CAS  PubMed  Google Scholar 

  93. Triantafillidis JK, Dadioti P, Nicolakis D et al (1990) High doses of 5-aminosalicylic acid enemas in chronic radiation proctitis: comparison with betame-thasone enemas. Am J Gastroenterol 85:1537–1538

    CAS  PubMed  Google Scholar 

  94. Kochhar R, Sriram PV, Sharma SC et al (1999) Natural history of late radiation proctosigmoiditis treated with topical sucralfate suspension. Dig Dis Sci 44:973–978

    Article  CAS  PubMed  Google Scholar 

  95. O’Brien P, Tiver K, Bull C et al (1988) Acute symptoms, not rectally administered sucralfate, predict for late radiation proctitis: longer follow-up of a phase III trial Trans-Tasman Radiation Oncology group. Int J Radiat Oncol Biol Phys 54:442

    Google Scholar 

  96. Kneebone A, Mameghan H, Bolin T et al (2004) Effect of oral sucralfate on late rectal injury associated with radiotherapy for prostate cancer: A double-blind, randomized trial. Int J Radiat Oncol Biol Phys 60:1088–1097

    CAS  PubMed  Google Scholar 

  97. Talley NA, Chen F, King D et al (1997) Short-chain fatty acids in the treatment of radiation proctitis: a randomized, double-blind, placebo-controlled, cross-over pilot trial. Dis Colon Rectum 40(9):1046–1050

    Article  CAS  PubMed  Google Scholar 

  98. Villavicencio RT, Rex DK, Rahmani E (2002) Efficacy and complications of argon plasma coagulation for hematochezia related to radiation proctopathy. Gastrointest Endosc 55:70–74

    Article  PubMed  Google Scholar 

  99. Fantin AC, Binek J, Suter WR et al (1999) Argon beam coagulation for treatment of symptomatic radiation-induced proctitis. Gastrointest Endosc 49(4 Pt 1):515–518

    Article  CAS  PubMed  Google Scholar 

  100. Silva RA, Correia AJ, Dias LM et al (1999) Argon plasma coagulation therapy for hemorrhagic radiation proctosigmoiditis. Gastrointest Endosc 50:221–224

    Article  CAS  PubMed  Google Scholar 

  101. Kaasis M, Oberti F, Burtin P et al (2000) Argon plasma coagulation for the treatment of hemorraghic radiation proctitis. Endoscopy 32:673

    Article  Google Scholar 

  102. Sebastian S, O’Conner H, O’Morain C et al (2004) Argon plasma coagulation as first-line treatment for chronic radiation proctopathy. J Gastroenterol Hepatol 19:1169–1173

    Article  PubMed  Google Scholar 

  103. Karamanolis G, Triantafyllou K, Tsiamoulos Z et al (2009) Argon plasma coagulation has a long-lasting therapeutic effect in patients with chronic radiation proctitis. Endoscopy 41(6):529–531

    Article  CAS  PubMed  Google Scholar 

  104. De Parades V, Etienney I, Bauer P et al (2005) Formalin application in the treatment of chronic radiation-induced hemorrhagic proctitis—an effective but not risk-free procedure: a prospective study of 33 patients. Dis Colon Rectum 48:1535–1541

    Article  PubMed  Google Scholar 

  105. Ismail MA, Qureshi MA (2002) Formalin dab for haemorrhagic radiation proctitis. Ann R Coll Surg Engl 84:263–264

    Article  CAS  PubMed  Google Scholar 

  106. Chautems RC, Delgadillo X, Rubbia-Brandt L et al (2003) Formaldehyde application for haemorrhagic radiation-induced proctitis: a clinical and histological study. Colorectal Dis 5:24–28

    Article  CAS  PubMed  Google Scholar 

  107. Seow-Choen F, Goh HS, Eu KW et al (1993) A simple and effective treatment for hemorrhagic radiation proctitis using formalin. Dis Colon Rectum 36:135–138

    Article  CAS  PubMed  Google Scholar 

  108. Roche B, Chautems R, Marti MC (1996) Application of formaldehyde for treatment of hemorrhagic radiation-induced proctitis. World J Surg 20:1092–1094

    Article  CAS  PubMed  Google Scholar 

  109. Girnius S, Cersonsky N, Gesell L et al (2006) Treatment of refractory radiation-induced hemorrhagic proctitis with hyperbaric oxygen therapy. Am J Clin Oncol 29:588–592

    Article  PubMed  Google Scholar 

  110. Mayer R, Klemen H, Quehenberger F et al (2001) Hyperbaric oxygen—an effective tool to treat radiation morbidity in prostate cancer. Radiother Oncol 61:151–156

    Article  CAS  PubMed  Google Scholar 

  111. Clarke RE, Tenorio LM, Hussey JR et al (2008) Hyperbaric oxygen treatment of chronic refractory radiation proctitis: a randomized and controlled double-blind crossover trial with long-term follow-up. Int J Radiat Oncol Biol Phys 72:134–143

    CAS  PubMed  Google Scholar 

  112. Marks G, Mohiudden M (1983) The surgical management of the radiation-injured intestine. Surg Clin North Am 63:81–96

    CAS  PubMed  Google Scholar 

  113. Liu T, Liu Y, He S et al (1992) Use of radiation with or without WR-2721 in advanced rectal cancer. Cancer 69:2820–2825

    Article  CAS  PubMed  Google Scholar 

  114. Zelefsky MJ, Fuks Z, Hunt M et al (2002) High-dose intensity modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients. Int J Radiat Oncol Biol Phys 53:1111–1116

    Article  PubMed  Google Scholar 

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López Rodríguez, M., Martín Martín, M., Cerezo Padellano, L. et al. Gastrointestinal toxicity associated to radiation therapy. Clin Transl Oncol 12, 554–561 (2010). https://doi.org/10.1007/s12094-010-0553-1

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