Review
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World J Gastroenterol. Jan 14, 2013; 19(2): 199-208
Published online Jan 14, 2013. doi: 10.3748/wjg.v19.i2.199
Gastrointestinal radiation injury: Prevention and treatment
Abobakr K Shadad, Frank J Sullivan, Joseph D Martin, Laurence J Egan
Abobakr K Shadad, Laurence J Egan, Department of Gastroenterology, University Hospital Galway, University Hospital Galway, 34562 Galway, Ireland
Abobakr K Shadad, Laurence J Egan, Department of Pharmacology and Therapeutics, School of Medicine, University Hospital Galway, 34562 Galway, Ireland
Frank J Sullivan, Joseph D Martin, Department of Radiation Oncology, National University of Ireland Galway, University Hospital Galway, 34562 Galway, Ireland
Author contributions: Shadad AK wrote the review; Sullivan FJ, Martin JD and Egan LJ revised the contents.
Correspondence to: Laurence J Egan, Professor, Department of Pharmacology and Therapeutics, School of Medicine, University Hospital Galway, 34562 Galway, Ireland. laurence.egan@nuigalway.ie
Telephone: +353-91-495370 Fax: +353-91-495572
Received: December 4, 2011
Revised: March 31, 2012
Accepted: April 2, 2012
Published online: January 14, 2013
Abstract

With the recent advances in detection and treatment of cancer, there is an increasing emphasis on the efficacy and safety aspects of cancer therapy. Radiation therapy is a common treatment for a wide variety of cancers, either alone or in combination with other treatments. Ionising radiation injury to the gastrointestinal tract is a frequent side effect of radiation therapy and a considerable proportion of patients suffer acute or chronic gastrointestinal symptoms as a result. These side effects often cause morbidity and may in some cases lower the efficacy of radiotherapy treatment. Radiation injury to the gastrointestinal tract can be minimised by either of two strategies: technical strategies which aim to physically shift radiation dose away from the normal intestinal tissues, and biological strategies which aim to modulate the normal tissue response to ionising radiation or to increase its resistance to it. Although considerable improvement in the safety of radiotherapy treatment has been achieved through the use of modern optimised planning and delivery techniques, biological techniques may offer additional further promise. Different agents have been used to prevent or minimize the severity of gastrointestinal injury induced by ionising radiation exposure, including biological, chemical and pharmacological agents. In this review we aim to discuss various technical strategies to prevent gastrointestinal injury during cancer radiotherapy, examine the different therapeutic options for acute and chronic gastrointestinal radiation injury and outline some examples of research directions and considerations for prevention at a pre-clinical level.

Keywords: Radiation enteritis; Radiation proctitis; Prevention; Treatment; Gastrointestinal radiation injury