Management of Long-Term Toxicity From Pelvic Radiation Therapy.
Management of Long-Term Toxicity From Pelvic Radiation Therapy.
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DOI：
10.1200/edbk_323525
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发表时间：
2021-03-01
期刊：
影响因子：
--
通讯作者：
Willingham, Field F
中科院分区：
文献类型：
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作者：
Dalsania, Raj M;Shah, Kevin P;Willingham, Field F
盆腔放射治疗是各种胃肠道、妇科和泌尿生殖系统癌症治疗中不可或缺的组成部分。随着这些恶性肿瘤生存率的提高，继发于盆腔放射的毒性的患病率也增加了。胃肠道毒性是最常见的并发症，极大地影响生活质量。毒性可以出现在急性或晚期阶段;虽然两者的症状可能相似，但管理可能不同。急性毒性代表对辐射暴露的炎症反应，而晚期毒性可能是小血管疾病、缺血和纤维化的结果。目前，还没有大型临床试验，只有有限的指导方针管理晚期胃肠道放射毒性。治疗通常以逐步的方式进行，从医学到内窥镜到手术方法。几种内镜治疗，如氩等离子凝固治疗放射性直肠炎和扩张放射性肠狭窄，可以防止需要手术干预，这可能与高发病率和死亡率。鉴于放射治疗后数年可能发生晚期毒性，因此通常难以识别和诊断。晚期毒性的成功管理需要认识、对潜在病理生理学的理解和多学科方法。更专门的研究可以澄清胃肠道盆腔放射毒性的患病率，允许更好地了解当前疗法的疗效和安全性，并允许开发新的治疗方法。
Pelvic radiation therapy is an integral component in the treatment of various gastrointestinal, gynecologic, and genitourinary cancers. As survival rates from these malignancies improve, the prevalence of toxicity secondary to pelvic radiation has increased. Gastrointestinal toxicities are the most common complications and greatly impact quality of life. Toxicities can present in acute or late stages; although symptoms may be similar during both, the management may differ. Acute toxicities represent an inflammatory reaction in response to the radiation exposure, whereas late toxicities may arise as a result of small vessel disease, ischemia, and fibrosis. Currently, there are no large clinical trials and only limited guidelines on the management of late gastrointestinal radiation toxicities. Therapy is generally approached in a stepwise manner from medical to endoscopic to surgical methods. Several endoscopic therapies, such as the treatment of radiation proctitis with argon plasma coagulation and dilation of radiation bowel strictures, may prevent the need for surgical intervention, which may be associated with high morbidity and mortality. Given that late toxicities can occur years after radiation therapy, they are often difficult to recognize and diagnose. Successful management of late toxicities requires recognition, an understanding of the underlying pathophysiology, and a multidisciplinary approach. More dedicated research could clarify the prevalence of gastrointestinal pelvic radiation toxicities, permit a better understanding of the efficacy and safety profile of current therapies, and allow for the development of novel therapeutic approaches.