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Parfenov AI, Indejkina LK, Sabelnikova EA, Leontiev AV, Makarova AA. [Radiation-induced intestinal injury]. TERAPEVT ARKH 2025; 97:101-108. [PMID: 40237744 DOI: 10.26442/00403660.2025.02.203116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 02/19/2025] [Indexed: 04/18/2025]
Abstract
This article addresses theoretical and clinical aspects of radiation-induced intestinal injuries, which complicate radiation therapy for malignant neoplasms of the abdominal and pelvic organs. Many clinical aspects of this issue remain unknown due to the lack of awareness among doctors and patients. Further study of radiation-induced intestinal injuries and the development of personalized approaches to their prevention and treatment represent a relevant direction in internal medicine.
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Affiliation(s)
| | - L K Indejkina
- Loginov Moscow Clinical Scientific Center
- Research Institute for Healthcare and Medical Management
| | - E A Sabelnikova
- Loginov Moscow Clinical Scientific Center
- Russian University of Medicine
| | - A V Leontiev
- Loginov Moscow Clinical Scientific Center
- Moscow University for Industry and Finance "Synergy"
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Leontiev AV, Indejkina LK, Danilov MA, Sabelnikova EA, Orlyuk MA, Abramov KO, Makarova AA, Parfenov AI. [Chronic small bowel obstruction in a patient with post-radiation enteropathy. Case report]. TERAPEVT ARKH 2025; 97:193-197. [PMID: 40237757 DOI: 10.26442/00403660.2025.02.203119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Accepted: 01/20/2025] [Indexed: 04/18/2025]
Abstract
Сase report of late radiation damage to the small intestine in a patient who underwent laparoscopic extirpation of uterine cancer and radiation therapy is presented. The article shows the clinical manifestations of chronic post-radiation enteritis with a long progressive course and the development of partial intestinal obstruction, demonstrating the importance of timely diagnosis and the implementation of a multidisciplinary approach in the treatment of patients with late radiation damage to the intestine.
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Affiliation(s)
- A V Leontiev
- Loginov Moscow Clinical Scientific Center
- Moscow University for Industry and Finance "Synergy"
| | - L K Indejkina
- Loginov Moscow Clinical Scientific Center
- Research Institute for Healthcare Organization and Medical Management
| | | | - E A Sabelnikova
- Loginov Moscow Clinical Scientific Center
- Russian University of Medicine
| | - M A Orlyuk
- Moscow University for Industry and Finance "Synergy"
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Liao Z, Hu X, Hu L, Yang J. High-risk factors and predictive models for hemorrhagic chronic radiation proctitis. Eur J Med Res 2025; 30:23. [PMID: 39794778 PMCID: PMC11724496 DOI: 10.1186/s40001-024-02266-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 12/30/2024] [Indexed: 01/13/2025] Open
Abstract
INTRODUCTION Hemorrhagic chronic radiation proctitis (CRP) is a common and challenging complication after pelvic radiation therapy. Identifying high-risk factors, predicting its occurrence, and optimizing radiotherapy plans are key to preventing hemorrhagic CRP. This study retrospectively examined potential risk factors and developed a nomogram to predict its onset. METHODS This retrospective study included cervical carcinoma patients who received pelvic radiotherapy at Chongqing University Cancer Hospital from March 2014 to December 2021. Hemorrhagic CRP was diagnosed by colonoscopy. Logistic regression identified factors for a nomogram model, which was evaluated using ROC curve, calibration curve, and decision curve analysis. RESULTS Among 221 patients, 125 were diagnosed with hemorrhagic CRP, occurring at a median of 14.45 months after pelvic radiotherapy. Age (≥ 54 years), weight (< 52 kg), and radiation dose (≥ 72 Gy) were identified as risk factors. A nomogram was developed, with AUC values of 0.741 and 0.74 in the training and validation cohorts. Decision and clinical impact curves showed the model's benefit over a probability range of 0.25 to 0.85 in both sets. CONCLUSION In this study, we constructed and developed a nomogram for predicting hemorrhagic CRP risk. The good results in calibration curves, ROC curve analysis, and decision curves indicated that the nomogram had promise for clinical application. It may serve as a reference for radiologists in designing radiotherapy plan to help mitigate the risk of hemorrhagic CRP.
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Affiliation(s)
- Zhongli Liao
- Department of Clinical Nutrition, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiaogang Hu
- Department of Pharmacy, Jiulongpo People's Hospital, Chongqing, China
| | - Liuling Hu
- Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jian Yang
- Department of Clinical Nutrition, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Treechairusame T, Taweesedt PT. Carbon ion radiation therapy in prostate cancer: The importance of dosage. World J Radiol 2024; 16:696-699. [PMID: 39635316 PMCID: PMC11612798 DOI: 10.4329/wjr.v16.i11.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 10/11/2024] [Accepted: 11/01/2024] [Indexed: 11/27/2024] Open
Abstract
In this article, we comment on the article by Ono et al. We focus specifically on the carbon ion radiotherapy studies and the method to calculate the dosing schedule. While photon hypofractionated radiotherapy in prostate cancer has demonstrated improvement in tumor control with reduced gastrointestinal toxicity compared to conventional radiotherapy, carbon ion radiotherapy (CIRT) offers additional physical and biological advantages. Recent findings, including those from Ono et al, have established new dose constraints of CIRT for prostate cancer treatment and risk factors for rectal bleeding. Due to limited data on CIRT dosing, this study underscores the need for more research to refine dose calculation methods and better understand their effects on clinical outcomes.
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Affiliation(s)
- Teeradon Treechairusame
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Pahnwat T Taweesedt
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, United States
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA 94304, United States
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Bae BK, Kim JE, Pyo H, Hong SN, Park W. Long-term findings of rectal endoscopy and rectal bleeding after moderately hypofractionated, intensity-modulated radiotherapy for prostate cancer. Sci Rep 2023; 13:22099. [PMID: 38092835 PMCID: PMC10719280 DOI: 10.1038/s41598-023-43202-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 09/21/2023] [Indexed: 12/17/2023] Open
Abstract
To present rectal endoscopic findings and toxicity after definitive moderately hypofractionated, intensity-modulated radiotherapy (IMRT) for prostate cancer. We retrospectively reviewed patients who underwent IMRT for prostate cancer and underwent post-radiotherapy endoscopies between 2008 and 2018. Endoscopic findings were reviewed and graded using Vienna Rectoscopy Score (VRS). We have analyzed the association between endoscopic findings and rectal bleeding, and investigated risk factors for rectal bleeding. Total 162 patients met the inclusion criteria of this study. There was a trend of VRS worsening during the initial 3 years after radiotherapy followed by recovery. Rectal bleeding was highest at 1 year after radiotherapy and improved thereafter. The 5-year cumulative incidence of grade ≥ 2 rectal bleeding was 14.8%. In the multivariable Cox regression analysis, cardiovascular disease (hazard ratio [HR] 2.732, P = 0.037), rectal wall V65 (HR 1.158, P = 0.027), and VRS ≥ 3 in first post-radiotherapy endoscopy (HR 2.573, P = 0.031) were significant risk factors for rectal bleeding. After IMRT for prostate cancer, VRS and rectal bleeding worsened over 1-3 years after radiotherapy and recovered. Cardiovascular disease, rectal wall V65, and VRS ≥ 3 in first post-radiotherapy endoscopy were significant risk factors for rectal bleeding.
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Affiliation(s)
- Bong Kyung Bae
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ji Eun Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Noh Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Zhang H, Zhang Z, Yuan S. Chinese clinical practice guidelines for the prevention and treatment of radiation-induced rectal injury. PRECISION RADIATION ONCOLOGY 2023; 7:237-255. [PMID: 40336868 PMCID: PMC11935203 DOI: 10.1002/pro6.1217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 05/09/2025] Open
Abstract
Although radiotherapy plays an important role in the treatment of cancer, it may have negative effects in some individuals. Rectal injury is a common adverse effect of abdominal and pelvic radiotherapy. This injury is caused by administering radiation to the abdomen. Appropriate treatment techniques can be determined if doctors have a better understanding of the incidence, risk factors, and clinical symptoms of radiation-induced rectal injuries. Studies on the underlying pathophysiology of radiation-induced rectal injury may aid in the development of effective treatment and prevention strategies. The implementation of efficient preventive measures can improve the quality of life of patients with cancer and make it easier for them to complete their treatment. Therefore, comprehensive and accurate assessments are crucial for developing holistic and individualized treatment plans for patients who have already developed symptoms, with early intervention being a priority.
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Affiliation(s)
- Hui Zhang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Zhen Zhang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- China Anti‐Cancer Association Tumor Support Therapy Committee
- China Anti‐Cancer Association Tumor Radiation Protection Committee
- Chinese Radiation Therapy Oncology Group
| | - Shuanghu Yuan
- China Anti‐Cancer Association Tumor Support Therapy Committee
- China Anti‐Cancer Association Tumor Radiation Protection Committee
- Chinese Radiation Therapy Oncology Group
- Department of RadiologyShandong Cancer HospitalJinanChina
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Someya M, Hasegawa T, Nakamura AJ, Tsuchiya T, Kitagawa M, Gocho T, Mafune S, Ikeuchi Y, Tauchi H, Sakata KI. Prediction of late adverse events in pelvic cancer patients receiving definitive radiotherapy using radiation-induced gamma-H2AX foci assay. JOURNAL OF RADIATION RESEARCH 2023; 64:948-953. [PMID: 37839163 PMCID: PMC10665300 DOI: 10.1093/jrr/rrad079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/21/2023] [Indexed: 10/17/2023]
Abstract
Radiation can induce DNA double-stranded breaks, which are typically detected by the fluorescence of phosphorylated histone H2AX. In this study, we examined the usefulness of the dynamics of radiation-induced gamma-H2AX foci of peripheral blood lymphocytes (PBLs), as a marker of DNA repair ability, in predicting late adverse events from radiotherapy. A total of 46 patients with cervical, vaginal and anal canal cancers treated with radical radiotherapy between 2014 and 2019 were included in this analysis. Concurrent chemotherapy was administered in 36 cases (78.3%). Peripheral blood was obtained before treatment, and then irradiated ex vivo with 1 Gy X-ray. The ratio of radiation-induced gamma-H2AX foci in PBLs measured at 30 min and at 4 h was defined as the foci decay ratio (FDR). With a median follow-up of 54 months, 9 patients (19.6%) were observed to have late genitourinary or gastrointestinal (GU/GI) toxicity. The FDR ranged from 0.51 to 0.74 (median 0.59), with a significantly higher incidence of Grade 1 or higher late adverse events in the FDR ≥ 0.59 group. In multivariate analysis, FDR ≥ 0.59 and hypertension also emerged as significant factors associated with the development of late toxicities. Overall, our results suggest that measurement of radiation-induced gamma-H2AX foci in PBLs may predict the risk of late GU/GI toxicities from chemoradiotherapy, which can enable tailoring the radiation dose to minimize adverse effects.
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Affiliation(s)
- Masanori Someya
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Tomokazu Hasegawa
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Asako J Nakamura
- Department of Biological Sciences, College of Sciences, Ibaraki University, Bunkyo 2-1-1, Mito, Ibaraki 310-8512, Japan
| | - Takaaki Tsuchiya
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Mio Kitagawa
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Toshio Gocho
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Sho Mafune
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Yutaro Ikeuchi
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Hiroshi Tauchi
- Department of Biological Sciences, Faculty of Sciences, Ibaraki University, Bunkyo 2-1-1, Mito, Ibaraki 310-8512, Japan
| | - Koh-ichi Sakata
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
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Gregucci F, Carbonara R, Surgo A, Ciliberti MP, Curci D, Ciocia A, Branà L, Ludovico GM, Scarcia M, Portoghese F, Caliandro M, Ludovico E, Paulicelli E, Di Guglielmo FC, Bonaparte I, Fiorentino A. Extreme hypofractionated stereotactic radiotherapy for elderly prostate cancer patients: side effects preliminary analysis of a phase II trial. LA RADIOLOGIA MEDICA 2023; 128:501-508. [PMID: 36952115 DOI: 10.1007/s11547-023-01618-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Aim of this study is to evaluate safety and efficacy of SBRT in elderly patients affected by localized prostate cancer (PC). MATERIAL AND METHODS Men aged 70 years or older were enrolled and analyzed. The SBRT schedule was 35 Gy in 5 fractions administered in 1-2 weeks. According to risk group, androgen deprivation therapy (ADT) was prescribed. Urinary symptoms were evaluated at baseline using the International Prostate Symptom Score (IPSS). Genitourinary (GU) and gastrointestinal (GI) toxicities were assessed at the end of treatment, 2 weeks after SBRT and during follow-up using the Common Terminology Criteria for Adverse Events (CTCAE). PSA values were recorded before treatment and during follow-up as biochemical response criteria. RESULTS Between 07/2019 and 09/2021, 111 patients were enrolled. Median age was 77 years. At the end of treatment, no acute GU/GI toxicities ≥ G2 were observed. At 2-3 weeks after treatment, 3 patients reported G2 GU toxicity, while 14 patients referred G2 GI toxicity. During the last follow up, 26 and 2 patients reported, respectively, G1 and G2 GU toxicity, while 22 and 1 cases described, respectively, G1 and G2 GI toxicity. No late toxicities ≥ G3 were recorded. GU toxicity is related to absence of urethra sparing, increasing PTV volume, Dmax PTV and IPSS; GI toxicity is related to RT schedule (each other day is better than consecutive day), Dmax rectum and IPSS, At a median follow-up of 24 months, excellent biochemical disease control was achieved in all cases with median PSA of 0.5 ng/ml. CONCLUSION SBRT in elderly patients affected by PC is feasible and well tolerated with excellent biochemical disease control. Longer follow-up is needed to assess late toxicity profile and long-term clinical outcome.
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Affiliation(s)
- Fabiana Gregucci
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Roberta Carbonara
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Alessia Surgo
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy.
| | - Maria Paola Ciliberti
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Domenico Curci
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Annarita Ciocia
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Luciana Branà
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | | | - Marcello Scarcia
- Urology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Filippo Portoghese
- Urology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Morena Caliandro
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Elena Ludovico
- Radiology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Eleonora Paulicelli
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | | | - Ilaria Bonaparte
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
- Department of Medicine, LUM Giuseppe Degennaro University, Casamassima, Bari, Italy
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