From radiation osteitis to osteoradionecrosis: incidence and MR morphology of radiation-induced sacral pathologies following pelvic radiotherapy

Radiation-induced emesis (RIE) is usually noted during abdominal-pelvic radiotherapy. In gynecological malignancies, it is usually noted in para-aortic but not whole-pelvic irradiation. Irradiated small bowel (SB) may be associated with RIE. The significance of SB dosimetry remains unclear. Dosimetric and non-dosimetric factors were evaluated and correlated with RIE in 45 patients with gynecological malignancies undergoing extended-field radiotherapy (EFRT) (median 45 Gy) from 2006 to 2021. Early-onset RIE (within 72 h after the first fraction of EFRT) was noted in 10 of 12 RIE patients. RIE was significantly associated with the SB mean dose. The RIE rates were 58.3% and 15.2% (p = 0.007) in patients with a low (<63%) and high (≥63%) SB mean dose. Logistic regression revealed that the SB mean dose remained the independent factor of overall RIE (p = 0.049) and early-onset RIE (p = 0.014). Therefore, constraint of the SB mean dose limited to less than 63% of the prescribed dose is suggested to decrease RIE.

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Sulfasalazine Decreases Acute Gastrointestinal Complications Due to Pelvic Radiotherapy

Annals of Pharmacotherapy ◽

10.1345/aph.10055 ◽

2001 ◽

Vol 35 (7-8) ◽

pp. 806-810 ◽

Cited By ~ 13

Author(s):

Diclehan Kilic ◽

Seren Ozenirler ◽

Ibrahim Egehan ◽

Ayse Dursun

Keyword(s):

Gastrointestinal Toxicity ◽

Double Blind Study ◽

Pelvic Radiotherapy ◽

Double Blind ◽

Gastrointestinal Complications ◽

Pelvic Malignancies ◽

Long Term Follow Up ◽

Radiation Induced

BACKGROUND: Radiation-induced gastrointestinal toxicity is a significant concern for patients who are treated with this modality for pelvic malignancies. Eicosanoids and free radicals are thought to be among the reasons for this effect. Sulfasalazine is an inhibitor of their synthesis in the mucosa. OBJECTIVE: To determine whether sulfasalazine can reduce the radiation-induced acute gastrointestinal complications. METHODS: In this prospective, double-blind study, 31 patients receiving pelvic radiotherapy were randomized to receive two sulfasalazine 500-mg tablets twice daily or placebo, administered orally from the first day of irradiation. Patients were evaluated weekly, and gastrointestinal toxicities were graded according to the Late Effect of Normal Tissue — Subjective Objective Management Analytic (LENT-SOMA) toxicity table during pelvic radiotherapy. On the last day of week 5, the subjects were graded endoscopically, and biopsies taken from the rectum were classified histopathologically. RESULTS: Groups did not differ in age, gender, tumor site, or irradiation procedure. During radiotherapy, grade 2 or higher gastrointestinal toxicity occurred in 20% (3/15) and 63% (10/16) of the sulfasalazine and placebo groups, respectively. This difference was significant (p = 0.017). No statistically significant differences were found in endoscopic and histopathologic evaluations. CONCLUSIONS: Sulfasalazine is effective in decreasing clinically acute gastrointestinal toxicities. Long-term follow-up with the subjects will help to determine the net effect of sulfasalazine on the radiation-induced gastrointestinal injuries.

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Food Supplements to Mitigate Detrimental Effects of Pelvic Radiotherapy

Microorganisms ◽

10.3390/microorganisms7040097 ◽

2019 ◽

Vol 7 (4) ◽

pp. 97 ◽

Cited By ~ 2

Author(s):

Charlotte Segers ◽

Mieke Verslegers ◽

Sarah Baatout ◽

Natalie Leys ◽

Sarah Lebeer ◽

...

Keyword(s):

Gut Microbiome ◽

Molecular Mechanisms ◽

Late Onset ◽

Cell Types ◽

Intestinal Wall ◽

Food Supplements ◽

Pelvic Radiotherapy ◽

Pelvic Radiation ◽

Microbial Dysbiosis ◽

Radiation Induced

Pelvic radiotherapy has been frequently reported to cause acute and late onset gastrointestinal (GI) toxicities associated with significant morbidity and mortality. Although the underlying mechanisms of pelvic radiation-induced GI toxicity are poorly understood, they are known to involve a complex interplay between all cell types comprising the intestinal wall. Furthermore, increasing evidence states that the human gut microbiome plays a role in the development of radiation-induced health damaging effects. Gut microbial dysbiosis leads to diarrhea and fatigue in half of the patients. As a result, reinforcement of the microbiome has become a hot topic in various medical disciplines. To counteract GI radiotoxicities, apart from traditional pharmacological compounds, adjuvant therapies are being developed including food supplements like vitamins, prebiotics, and probiotics. Despite the easy, cheap, safe, and feasible approach to protect patients against acute radiation-induced toxicity, clinical trials have yielded contradictory results. In this review, a detailed overview is given of the various clinical, intestinal manifestations after pelvic irradiation as well as the role of the gut microbiome herein. Furthermore, whilst discussing possible strategies to prevent these symptoms, food supplements are presented as auspicious, prophylactic, and therapeutic options to mitigate acute pelvic radiation-induced GI injury by exploring their molecular mechanisms of action.

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Randomized controlled trial of dietary fiber for the prevention of radiation-induced gastrointestinal toxicity during pelvic radiotherapy

American Journal of Clinical Nutrition ◽

10.3945/ajcn.116.150565 ◽

2017 ◽

pp. ajcn150565 ◽

Cited By ~ 6

Author(s):

Linda Wedlake ◽

Clare Shaw ◽

Helen McNair ◽

Amyn Lalji ◽

Kabir Mohammed ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Dietary Fiber ◽

Controlled Trial ◽

Gastrointestinal Toxicity ◽

Pelvic Radiotherapy ◽

Randomized Controlled ◽

Radiation Induced

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Balsalazide reduces the incidence of radiation-induced proctosigmoiditis and other toxicities associated with pelvic radiotherapy,

Inpharma Weekly ◽

10.2165/00128413-200515130-00022 ◽

2005 ◽

Vol &NA; (1513) ◽

pp. 8

Author(s):

&NA;

Keyword(s):

Pelvic Radiotherapy ◽

Radiation Induced

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The impact of pelvic radiotherapy on the gut microbiome and its role in radiation-induced diarrhoea: a systematic review

Radiation Oncology ◽

10.1186/s13014-021-01899-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Lina Wang ◽

Xiaohu Wang ◽

Guangwen Zhang ◽

Yan Ma ◽

Qiuning Zhang ◽

...

Keyword(s):

Gut Microbiota ◽

Gut Microbiome ◽

Primary Tumour ◽

Intestinal Flora ◽

Radiation Enteritis ◽

Cochrane Library ◽

Pelvic Radiotherapy ◽

Pelvic Malignancies ◽

Radiation Induced ◽

The Impact

AbstractPelvic radiotherapy is the key treatment for pelvic malignancies, usually including pelvic primary tumour lesions and lymphatic drainage areas in the pelvic region. Therefore, the intestinal tract in the radiation field is inevitably damaged, a phenomenon clinically referred to as radiation enteritis, and diarrhoea is the most common clinical symptom of radiation enteritis. Therefore, it is necessary to study the mechanism of radiation-induced diarrhoea. It has been found that the gut microbiome plays an important role in the development of diarrhoea in response to pelvic radiotherapy, and the species and distribution of intestinal microbiota are significantly altered in patients after pelvic radiotherapy. In this study, we searched for articles indexed in the Cochrane Library, Web of Science, EMBASE and PubMed databases in English and CNKI, Wanfang data and SINOMED in Chinese from their inception dates through 13 March 2020 to collect studies on the gut microbiome in pelvic radiotherapy patients. Eventually, we included eight studies: one study report on prostatic carcinoma, five studies on gynaecological carcinoma and two papers on pelvic carcinomas. All studies were designed as self-controlled studies, except for one that compared toxicity to nontoxicity. The results from all the studies showed that the diversity of intestinal flora decreased during and after pelvic radiotherapy, and the diversity of intestinal flora decreased significantly in patients with diarrhoea after radiotherapy. Five studies observed that the community composition of the gut microbiota changed at the phylum, order or genus level before, during, and after pelvic radiotherapy at different time points. In addition, the composition of the gut microbiota before radiotherapy was different between patients with postradiotherapy diarrhoea and those without diarrhoea in five studies. However, relevant studies have not reached consistent results regarding the changes in microbiota composition. Changes in the intestinal flora induced by pelvic radiotherapy and their relationship between changes in intestinal flora and the occurrence of radiation-induced diarrhoea (RID) are discussed in this study, providing a theoretical basis for the causes of RID after pelvic radiotherapy.

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