Gastrointestinal Toxicity of Pelvic Radiotherapy: Are We Letting Women Down?

Fernandes, Darren; Andreyev, H. J. N.

doi:10.1016/j.clon.2021.04.009

Cited by 12 publications

(7 citation statements)

References 108 publications

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“… 17 In combination with increased cancer survival rates and life expectancies, these factors ensure that gastrointestinal toxicity following radiotherapy remains a relevant challenge. 18 Our case report suggests that infliximab can potentially serve as a therapeutic agent for chronic bowel dysfunction after radiotherapy. However, because of the powerful biological effects of infliximab, caution is required.…”

Section: Discussionmentioning

confidence: 75%

Remarkable effects of infliximab on severe radiation-induced side effects in a patient with uterine cervical cancer: a case report

Toft Morén,

Bull,

Bergmark

2023

J Int Med Res

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Pelvic radiotherapy is a powerful treatment for a broad range of cancers, including gynecological, prostate, rectal, and anal cancers. Despite improvements in the delivery of ionizing beams, damage to non-cancerous tissue can cause long-term effects that are potentially severe, affecting quality of life and daily function. There is an urgent need for new strategies to treat and reverse the side effects of pelvic radiotherapy without compromising the antitumor effect. A woman with severe radiation-induced intestinal side effects was treated with the tumor necrosis factor-alpha inhibitor infliximab with a dose of 3 mg/kg every 4 to 6 weeks. With infliximab treatment, a remarkable improvement in her bowel health was observed. The patient’s late bowel toxicity was reduced from Grade 2 to Grade 0 (RTOG/EORTC Late Radiation Morbidity Scale). Although it is necessary to proceed cautiously because of the risk of serious side effects from immunosuppressants, our case suggests that infliximab can be used to treat symptoms of chronic bowel dysfunction after radiotherapy.

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Section: Discussionmentioning

confidence: 75%

Remarkable effects of infliximab on severe radiation-induced side effects in a patient with uterine cervical cancer: a case report

Toft Morén,

Bull,

Bergmark

2023

J Int Med Res

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“…Patient-related adverse factors are primary tumor site, advanced age, female sex, obesity, comorbidities, previous pelvic or abdominal surgery, low body mass index, radiosensitivity-inducing diseases, malnutrition, immune system insu ciency, alcohol drinking, and tobacco smoking. Treatment-related adverse factors are administration of high ionizing radiation dose, large volume of RT, utilization of nonconventional fractionation RT scheme, reirradiation of the same RT eld, utilization of different treatment modalities concurrently (e.g., systemic therapy) or sequentially (e.g., brachytherapy), and usage of non-IMRT techniques [20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Ninety-degree angled collimator: a dosimetric study related to dynamic intensity-modulated radiotherapy in patients with endometrial carcinoma

Serarslan

Dastan

Aksu

et al. 2023

Preprint

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Background Our purpose was to ensure that the dose constraints of the organs at risk (OARs) were not exceeded while increasing the prescription dose to the planning target volume (PTV) from 45 Gy to 50.4 Gy with the dynamic intensity-modulated radiotherapy (IMRT) technique. While trying for this purpose, a new dynamic IMRT technique that named 90° angled collimated dynamic IMRT (A-IMRT) planning was developed by us. Methods This study was based on the computed tomography data sets of 20 patients with postoperatively diagnosed International Federation of Gynecology and Obstetrics stage 2 endometrial carcinoma. For each patient, conventional dynamic IMRT (C-IMRT, collimator angle of 0° at all gantry angles), A-IMRT (collimator angle of 90° at gantry angles of 110°, 180°, 215°, and 285°), and volumetric modulated arc therapy (VMAT) were planned. Planning techniques were compared with parameters used to evaluate PTV and OARs via dose-volume-histogram analysis using the paired two-tailed Wilcoxon’s signed-rank test; p < 0.05 was considered indicative of statistical significance. Results All plans achieved adequate dose coverage for PTV. Conformality was best obtained with VMAT, whereas homogeneity was best obtained with C-IMRT. The conformality of A-IMRT was inferior to the conformality of C-IMRT; A-IMRT had similar homogeneity to VMAT. The bone marrow dose constraint was exceeded in 4 (20%), 16 (80%), and 18 (90%) patients with VMAT, A-IMRT, and C-IMRT, respectively. The bladder dose constraint was exceeded in no patients with A-IMRT or VMAT, but it was exceeded in 19 (95%) patients with C-IMRT. Dose constraints of the rectum and bilateral femoral heads were exceeded in no patients with A-IMRT or VMAT, but they were exceeded in 20 (100%) patients with C-IMRT. The dose constraint of the bowel (for V40 as in the RTOG 0418 trial) was exceeded in 4 (20%), 5 (25%), and 8 (40%) patients with VMAT, A-IMRT, and C-IMRT, respectively. Conclusions OARs are better protected when external beam radiotherapy is applied to the pelvis at a dose of 50.4 Gy by turning the collimator angle to 90° at some gantry angles with the dynamic IMRT technique in the absence of VMAT.

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“…On the other hand, the few existing studies on the late-phase pathology after pelvic radiotherapy have mainly focused on men with prostate cancer and whether studies are relevant in the context of gynecological cancer survivors is unknown. 44 Ferreira et al. found no evidence of pro-inflammatory activity when measuring cytokine levels in the rectal mucosal tissues of nine prostate cancer survivors, 14 but prostate cancer survivors are subjected to a smaller radiation field and a different dose regimen compared to gynecological cancer patients.…”

Section: Discussionmentioning

confidence: 99%

Low-grade intestinal inflammation two decades after pelvic radiotherapy

Devarakonda,

Thorsell,

Hedenström

et al. 2023

eBioMedicine

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Gastrointestinal Toxicity of Pelvic Radiotherapy: Are We Letting Women Down?

Cited by 12 publications

References 108 publications

Remarkable effects of infliximab on severe radiation-induced side effects in a patient with uterine cervical cancer: a case report

Remarkable effects of infliximab on severe radiation-induced side effects in a patient with uterine cervical cancer: a case report

Ninety-degree angled collimator: a dosimetric study related to dynamic intensity-modulated radiotherapy in patients with endometrial carcinoma

Low-grade intestinal inflammation two decades after pelvic radiotherapy

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