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Therapeutic Advances in Chronic Disease Jan 2014Ionizing radiation is commonly used to treat a number of malignancies. Although highly effective and now more targeted, many patients suffer side effects. The number of... (Review)
Review
Ionizing radiation is commonly used to treat a number of malignancies. Although highly effective and now more targeted, many patients suffer side effects. The number of cancer survivors has increased and so there are more patients presenting with symptoms that have arisen as a result of radiotherapy. Radiation damage to small bowel tissue can cause acute or chronic radiation enteritis producing symptoms such as pain, bloating, nausea, faecal urgency, diarrhoea and rectal bleeding which can have a significant impact on patient's quality of life. This review outlines the pathogenesis of radiation injury to the small bowel along with the prevention of radiation damage via radiotherapy techniques plus medications such as angiotensin-converting enzyme inhibitors, statins and probiotics. It also covers the treatment of both acute and chronic radiation enteritis via a variety of medical (including hyperbaric oxygen), dietetic, endoscopic and surgical therapies.
PubMed: 24381725
DOI: 10.1177/2040622313510730 -
Cancer Management and Research 2022To investigate the risk factors of radiation enteritis in patients with cervical cancer after radiotherapy.
PURPOSE
To investigate the risk factors of radiation enteritis in patients with cervical cancer after radiotherapy.
PATIENTS AND METHODS
Retrospective analysis 90 cervical cancer patients receiving radiation therapy from January 2019 to May 2021 in Hefei Cancer Hospital, Chinese Academy of Sciences. The patients were divided into radiation enteritis group and control group according to the radiation enteritis, the continuous variable were analyzed by ROC to obtain the best truncation value, and univariate and multifactorial logistic regression models analyzed the independent risk factors for radiation enteritis in cervical cancer patients. Nomogram was constructed and evaluated based on independent risk factors.
RESULTS
The radiation enteritis incidence rate was 35.56%. Univariate analysis found that hemoglobin (OR=4.25, 95% CI=1.43~13.73), albumin (OR=2.33, 95% CI=0.95~5.83), hypertension (OR=3.57, 95% CI=1.24~10.90), sigmoid colon V45(OR=0.41, 95% CI=0.15~1.03), external radiation dose (OR=0.45, 95% CI=0.18~1.08), age (OR=2.27, 95% CI=0.90~6.18), total T lymphocyte count (OR=2.4, 95% CI=0.97~6.29)(p<0.1) are risk factors for radiation enteritis. Multivariate logistic regression analysis found that hemoglobin (p=0.001, OR=13.22, 95% CI=3.03~72.65), albumin (p=0.003, OR=6.76, 95% CI=2.08~25.67), total T lymphocyte count (p=0.015, OR=4.79, 95% CI=1.45~13.38) were independent risk factors for radiation enteritis. Based on the above predictors, a nomogram model is established, and the area under the model fit, C-index, and ROC curve indicates that the model has good prediction efficiency and differentiation.
CONCLUSION
Hemoglobin, albumin, and total T lymphocyte count are risk factors for radiation enteritis in cervical cancer patients under radiotherapy, the nomogram model based on the above risk factors has good predictive efficacy and can provide a reference for radiation enteritis prediction.
PubMed: 36465709
DOI: 10.2147/CMAR.S383909 -
Journal of Radiation Research Mar 2022Patients receiving pelvic or abdominal radiotherapy may experience acute and/or chronic side effects due to gastrointestinal changes. However, effective medicine for...
Patients receiving pelvic or abdominal radiotherapy may experience acute and/or chronic side effects due to gastrointestinal changes. However, effective medicine for treating radiation enteritis has not been found yet. Sargentodoxa cuneata is a famous Chinese medicine used to treat intestinal inflammation, and our research team has found the main biologically active compound through its extraction, which is Liriodendrin. In this study, we found that Liriodendrin can reduce the expression of Cer, Cer1P and S1P in the sphingolipid pathway, thereby reducing the histological damage to the intestinal tract of mice and inhibiting the apoptosis of intestinal tissue cells. In addition, Liriodendrin can reduce the levels of pro-inflammatory cytokines (IL-6 and TNF-α), and it is suggested through flow cytometry that the proportion of neutrophils in the intestinal tissue can decrease due to the existence of Liriodendrin. At the same time, the western blot evaluation revealed that Liriodendrin significantly inhibited the activation of Bcl-2/Bax/Caspase-3 and NF-κB signaling pathways. The results show that Liriodendrin can inhibit intestinal inflammation and intestinal cell apoptosis through the sphingolipid pathway. Therefore, the aforementioned results demonstrated that Liriodendrin may be a promising drug for the treatment of radiation enteritis.
Topics: Animals; Enteritis; Furans; Glucosides; Mice; NF-kappa B; Radiation Injuries
PubMed: 35059715
DOI: 10.1093/jrr/rrab128 -
World Journal of Gastroenterology Jan 2013Ionising radiation therapy is a common treatment modality for different types of cancer and its use is expected to increase with advances in screening and early... (Review)
Review
Ionising radiation therapy is a common treatment modality for different types of cancer and its use is expected to increase with advances in screening and early detection of cancer. Radiation injury to the gastrointestinal tract is important factor working against better utility of this important therapeutic modality. Cancer survivors can suffer a wide variety of acute and chronic symptoms following radiotherapy, which significantly reduces their quality of life as well as adding an extra burden to the cost of health care. The accurate diagnosis and treatment of intestinal radiation injury often represents a clinical challenge to practicing physicians in both gastroenterology and oncology. Despite the growing recognition of the problem and some advances in understanding the cellular and molecular mechanisms of radiation injury, relatively little is known about the pathophysiology of gastrointestinal radiation injury or any possible susceptibility factors that could aggravate its severity. The aims of this review are to examine the various clinical manifestations of post-radiation gastrointestinal symptoms, to discuss possible patient and treatment factors implicated in normal gastrointestinal tissue radiosensitivity and to outline different mechanisms of intestinal tissue injury.
Topics: Gastrointestinal Tract; Humans; Neoplasms; Radiation Injuries; Radiotherapy; Radiotherapy Dosage; Risk Factors
PubMed: 23345941
DOI: 10.3748/wjg.v19.i2.185 -
Nutrients Oct 2018Radiotherapy has played a major role in both the curative and palliative treatment of cancer patients for decades. However, its toxic effect to the surrounding normal... (Review)
Review
Radiotherapy has played a major role in both the curative and palliative treatment of cancer patients for decades. However, its toxic effect to the surrounding normal healthy tissue remains a major drawback. In cases of intra-abdominal and/or pelvic malignancy, healthy bowel is inevitably included in the radiation field, causing undesirable consequences that subsequently manifest as radiation-induced bowel injury, which is associated with significant morbidity and mortality. The pathophysiology of radiation-induced bowel injury is poorly understood, although we now know that it derives from a complex interplay of epithelial injury and alterations in the enteric immune, nervous, and vascular systems in genetically predisposed individuals. Furthermore, evidence supporting a pivotal role for the gut microbiota in the development of radiation-induced bowel injury has been growing. In this review, we aim to appraise our current understanding of radiation-induced bowel injury and the role of the microbiome in its pathogenesis as well as prevention and treatment. Greater understanding of the relationship between the disease mechanism of radiation-induced bowel injury and gut microbiome might shed light on potential future prevention and treatment strategies through the modification of a patient's gut microbiome.
Topics: Gastrointestinal Microbiome; Humans; Intestinal Diseases; Intestines; Neoplasms; Radiation Injuries
PubMed: 30279338
DOI: 10.3390/nu10101405 -
Biomedicine & Pharmacotherapy =... Nov 2020Th17 cells are critical members in mediating immune responses of adaptive immunity. In humans and mice, gut is a main site where Th17 cells are resided, and Th17 cell... (Review)
Review
Th17 cells are critical members in mediating immune responses of adaptive immunity. In humans and mice, gut is a main site where Th17 cells are resided, and Th17 cell polarization also occurs in the gut. This process can be mediated by many factors, such as commensal bacteria, dendritic cells and cytokines, such as TGF-β and IL-6. Physiologically, polarized Th17 cells function in anti-infection and maintaining the integrity of intestinal epithelium. However, Th17 cells are plastic. For example, they will become pro-inflammatory cells if being exposed to IL-23. The pathogenic roles of Th17 cells have been well documented in inflammatory bowel disease. Besides, Th17 cells can accumulate in irradiated gut as well. Critically, radiation enteritis and inflammatory bowel disease present several similarities in disease pathology and pathophysiology. Herein, bacterial dysbiosis highly correlates with the pathogenicity of Th17 cells in inflammatory bowel disease. To our knowledge, radiation serves as a factor in inducing bacterial dysbiosis. Using this action, can Th17 cells be incited to promote inflammation in irradiated gut? In this review, we will sequentially introduce polarization of Th17 cells at steady state, radiation-induced Th17 accumulation in the gut, and advances in the management of radiation enteritis by using pharmacological therapy for bacterial dysbiosis.
Topics: Animals; Dysbiosis; Gastrointestinal Microbiome; Humans; Th17 Cells
PubMed: 32866810
DOI: 10.1016/j.biopha.2020.110674 -
Cancer Sep 2002Radiation enteritis is one of the most feared complications of abdominal and pelvic radiation. Once its occurs, the process is relentless and may result in the patient's... (Review)
Review
BACKGROUND
Radiation enteritis is one of the most feared complications of abdominal and pelvic radiation. Once its occurs, the process is relentless and may result in the patient's death. Available treatment is only supportive. Recent progress in molecular biology has shed some light on the pathogenesis of radiation enteritis and other diseases that are characterized by excessive fibrosis. New treatment modalities may be devised to improve the outcome of patients who are affected with this complication.
METHODS
A literature search was used to identify the common denominator between many radiation-induced fibrotic conditions and other sclerotic diseases. Factors that affect the disease process and possible therapeutic interventions were evaluated.
RESULTS
The hyperstimulation of transforming growth factor beta1 (TGF-beta1) leads to increased fibrosis and, ultimately, organ failure. Interferon gamma (IFN-gamma) inhibits the effects of TGF-beta1 in the nucleus. The fibrotic process may be reverted by IFN-gamma in various pathologic conditions.
CONCLUSIONS
Radiation enteritis and other radiation-induced, long-term complications are characterized by excessive stimulation of TGF-beta1. Preliminary studies suggest that IFN-gamma may be effective in the treatment of patients with radiation-induced cutaneous fibrosis. IFN-gamma should be considered in Phase I-II studies to assess its toxicity and efficacy in the treatment of patients with radiation enteritis.
Topics: Abdominal Neoplasms; Antineoplastic Agents; Clinical Trials as Topic; Enteritis; Fibrosis; Humans; Interferon-gamma; Radiotherapy; Transforming Growth Factor beta; Transforming Growth Factor beta1
PubMed: 12209703
DOI: 10.1002/cncr.10766 -
Gastroenterology Clinics of North... Dec 2003Acute diarrhea is commonly caused by an infection. Severe acute diarrhea warrants immediate medical evaluation and hospitalization. Indications for stool studies include... (Review)
Review
Acute diarrhea is commonly caused by an infection. Severe acute diarrhea warrants immediate medical evaluation and hospitalization. Indications for stool studies include fever; bloody diarrhea; recent travel to an endemic area; recent antibiotics; immunosuppression; and occupational risks, such as food handlers. Noninfectious causes include inflammatory bowel disease, radiation enteritis, and intestinal ischemia. Management of severe acute diarrhea includes intravenous fluid rehydration and empiric antibiotics. Use of antidiarrheal agents is controversial when invasive pathogens are suspected.
Topics: Acute Disease; Algorithms; Diagnosis, Differential; Diarrhea; Humans; Severity of Illness Index
PubMed: 14696306
DOI: 10.1016/s0889-8553(03)00100-6 -
Medicine Jun 2020Chronic radiation enteritis, a disease secondary to radiation exposure, has been widely reported in adults. However, few studies have described chronic radiation... (Review)
Review
RATIONALE
Chronic radiation enteritis, a disease secondary to radiation exposure, has been widely reported in adults. However, few studies have described chronic radiation enteritis in children. Early diagnosis is essential, and nutrition management plays an important role in pediatric chronic radiation enteritis management.
PATIENT CONCERNS
A Chinese 3-year-10-month-old boy was admitted with vomiting, weight loss (1-2 kg) after radiotherapy for a neuroblastoma.
DIAGNOSES
The patient was diagnosed as neuroblastoma (primary site: left adrenal grand; site of metastasis: multiple bone metastasis, bone marrow invasion, intraperitoneal lymph node metastasis) in 2015. Five months after radiotherapy, he showed vomiting and weight loss with stricture in intestine and thickening intestinal wall in imaging finding. His daily intake was not sufficient and extra supplements were needed by intravenous infusion. He had a weight-for-age z score of -5.04, a weight-for-height z score of -6.19, a height-for-age z score of -2.22, and a body mass index-for-age z score of -5.87. The highest level of alanine aminotransferase was 1433 U/L. Those findings established a diagnosis of chronic radiation enteritis with intestinal failure, intestinal stenosis, severe malnutrition, and hepatic dysfunction.
INTERVENTIONS
This patient was treated by parenteral nutrition with minimal enteral feeding. Other treatments were aiming at complications during hospitalization.
OUTCOMES
The patient weaned off parenteral nutrition finally with nutrition status and quality of life improved. There were no signs of tumor recurrence during the 4-year follow-up.
LESSONS
Pediatric radiation enteritis is rare. Our study highlights the characteristics of pediatric chronic radiation enteritis. Nutrition therapy is an important part of the whole therapy strategy in pediatric chronic radiation enteritis.
Topics: Adrenal Gland Neoplasms; Child, Preschool; Enteral Nutrition; Enteritis; Humans; Magnetic Resonance Imaging; Male; Neuroblastoma; Radiation Exposure; Radiography
PubMed: 32569238
DOI: 10.1097/MD.0000000000020905 -
World Journal of Clinical Oncology Jun 2016Curcumin is widely reported to have remarkable medicinal - and antineoplastic - properties. This review details curcumin's relationship with radiotherapy (RT),... (Review)
Review
Curcumin is widely reported to have remarkable medicinal - and antineoplastic - properties. This review details curcumin's relationship with radiotherapy (RT), principally as a radiosensitizer for various malignancies and a radioprotector for normal tissues. First, examples of radiosensitization are provided for various cancers: Pediatric, lymphoma, sarcoma, prostate, gynecologic, pancreas, liver, colorectal, breast, lung, head/neck, and glioma. It is not the purpose of this article to comprehensively review all radiosensitization data; however, high-quality studies are discussed in relationship to currently-controversial RT questions for many cancers, and thus the importance of developing a natural radiosensitizer. Attention is then shifted to radioprotection, for which supporting research is discussed for the following RT toxicities: Dermatitis, pneumonitis, cataractogenesis, neurocognition, myelosuppression, secondary malignancies, and mucositis/enteritis. Though there is fewer data for radioprotection, the overall quality of clinical evidence is higher, and small clinical trials implicating the efficacy of curcumin for RT toxicities (vs placebo/current therapies) are also detailed. Though the overall level of evidence for curcumin as a radiosensitizer and radioprotector is low, it must be recognized that risks of adverse effects are exceedingly low, and clinicians may need to judge the yet-unproven rewards with low toxicity risks.
PubMed: 27298767
DOI: 10.5306/wjco.v7.i3.275