Radiother Oncol 1999 Oct;53(1):37-44 
<b>Therapeutic outcome and relation of acute and late side effects in the adjuvant radiotherapy of endometrial carcinoma stage I and II.</b> 
Weiss E, Hirnle P, Arnold-Bofinger H, Hess CF, Bamberg M Department of Radiation Oncology, University of Goettinigen, Germany. [Record supplied by publisher] 

...159 consecutive patients with stage I and II endometrial carcinoma were treated with external radiotherapy and vaginal brachytherapy after hysterectomy [and BSO] ... [radiation] side effects were evaluated, in particular with regard to the relation of acute and late toxicity. ... Acute toxicity was seen in 65.4% of patients, all grade 1 or 2, late toxicity grade 1 or 2 in 18.8%, grade 3 or 4 complications in 1.8%. The estimated 5-year freedom from late toxicity was 76.8%. <b>Seventy-seven percent of all patients with treatment interruptions or premature end of therapy experienced late injury.</b> In ten of 33 patients with late sequelae there was no free interval between early and late toxicity. No relation of radiation technique/fractionation and the rate of side effects was noticed. ... Adjuvant radiotherapy leads to excellent pelvic control, with few serious complications. <b>Major acute toxicity shows significant correlation with the incidence of severe late injury</b>, which we suggest to classify in part as consequential late effects. 
&&url PMID: 10624851 


Ginecol Obstet Mex 1999 Jul;67:341-5 
<b>[The treatment of rectorrhagia secondary to postradiation proctitis with 4% formalin].</b> [Article in Spanish] 
Coyoli-Garcia O, Alvarado-Cerna R, Corona Bautista A, Pacheco Perez M Servicio de Coloproctologia, Hospital Regional Lic. Adolfo Lopez Mateos, ISSSTE Mex., D.F. [Record supplied by publisher] 
Radiation proctitis is a common complication of radiotherapy for pelvic malignancies. In the chronic form it might lead to intractable or massive hemorrhage unresponsive to conventional therapy. In these cases surgery is associated with a high morbidity. Seven female patients previously treated with external beam radiation for carcinoma of the uterus and cervix were included. They had required multiple blood transfusions (median 2), and still had low hemoglobin rates and active hemorrhagic radiation proctitis... The formalin therapy is an effective, safe, simple and inexpensive treatment for rectal bleeding caused by radiation proctitis. 
&&url PMID: 10496056 


Rev Esp Med Nucl 1999 Aug;18(4):292-7 
<b>[Bone metastasis versus insufficiency fractures due to pelvic radiotherapy for gynecologic neoplasm].</b> [Article in Spanish] 
Martinez Caballero A, Moreno Yubero A, Caballero Carpena O, Serrano Vicente J, Verdu Rico J, Navarro Navarro M, Anton Leal M, Crespo Martinez C, Clemente Quiles J Servicio de Medicina Nuclear, Hospital Clinico Universitario San Juan, Alicante, Valencia, 03550, Espana. [Record supplied by publisher] 
Five cases of patients with gynecological neoplasm ... who underwent pelvic external radiotherapy and intracavitary brachytherapy in whom pathologic pelvic uptake was found in the bone scan are presented. The diagnosis was pelvic insufficiency fractures due to radiotherapy adverse effects on the skeletal system ... Both bone metastases and insufficiency fractures must be considered in the differential diagnosis of bone pain in irradiated pelvises. ... 
&&url PMID: 10481113


Int J Radiat Oncol Biol Phys 1998 Jul 1;41(4):835-41 Comment in: Int J Radiat Oncol Biol Phys. 1999 Jul 1;44(4):968-9 
<b>Sensory and motor dysfunction assessed by anorectal manometry in uterine cervical carcinoma patients with radiation-induced late rectal complication.</b> 
Kim GE, Lim JJ, Park W, Park HC, Chung EJ, Seong J, Suh CO, Lee YC, Park HJ. Department of Radiation Oncology, Yonsei Cancer Center, Seoul, Korea. 

 the effects of radiation on anorectal function in patients with carcinoma of the uterine cervix. ... Physiologic changes of the anorectum in patients with late radiation proctitis seem to be caused by a variety of sensory and/or motor dysfunctions in which many different mechanisms are working together. The reduced rectal reservoir capacity and impaired sensory functions were crucial factors for functional disorder in such patients. In addition, radiation damage to the external anal sphincter muscle was considered to be an important cause of motor dysfunction. 
&&url PMID: 9652846 


Gynecol Oncol 1999 Jan;72(1):10-5 
<b>Postoperative radiotherapy in early stage carcinoma of the uterine cervix: treatment results and prognostic factors.</b> 
Yeh SA, Wan Leung S, Wang CJ, Chen HC Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsiung, Taiwan. [Record supplied by publisher] 
Comparing 179 women [group 1] who had radical hysterectomy & postop irradiation, with 159 women [group2] who had radical hysterectomy & intracavitary brachytherapy: " The overall 5-year intestinal and urinary complication-free rate was 66 and 82%, respectively. The overall incidence of grade 3 or above late rectal and urinary sequelae was 10%. For patients sustaining leg lymphedema after radiotherapy, there was higher incidence of severe leg cellulitis which warranted antibiotics treatment." Copyright 1999 Academic Press. [abstract rewritten and heavily edited.] 
&&url PMID: 9889023 


J Surg Oncol 1997 Feb;64(2):109-14 
<b>Advances in prevention of radiation damage to visceral and solid organs in patients requiring radiation therapy of the trunk.</b> 
Ritter EF, Lee CG, Tyler D, Ferraro F, Whiddon C, Rudner AM, Scully S. Duke University Medical Center, Durham, North Carolina 27710, USA. 
... <b>We detail our use of saline breast implants placed in polyglycolic acid mesh sheets to displace visceral and solid organs away from the radiation field. RESULTS: Analysis of CT scans and dose volume histograms reveal that this technique successfully displaces uninvolved organs away from the radiation fields, thereby minimizing the radiation dose to such organs and tissues. CONCLUSION: We believe this is a safe and efficacious method to prevent radiation damage to visceral and solid organs adjacent to trunk tumor sites.</b> 
&&url PMID: 9047246 


Gynecol Oncol 1996 Oct;63(1):40-6
<b>Arterial occlusion complicating treatment of gynecologic cancer: a case series.</b>
Levenback C, Burke TW, Rubin SC, Curtin JP, Wharton JT Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. [Record supplied by publisher]
.... <b>Three patients underwent amputation of a lower extremity when they developed chronic arterial insufficiency after pelvic radiotherapy. The patients were irradiated at the ages of 28, 30, and 35 years for cervix cancer in two patients and a low-grade retroperitoneal sarcoma in one patient. Two received neutron beam therapy and one received conventional photon beam therapy. All three had extensive late radiation morbidity to the bladder and rectum and had multiple prior surgeries. The amputations occurred at the ages of 48, 48, and 55 due to accelerated arteriosclerosis. Two patients died as a result of this complication. Acute and chronic arterial occlusions are rare yet dramatic complications of therapy for gynecologic cancer.</b> 
&&url PMID: 8898166


Am J Gastroenterol 1996 Jul;91(7):1309-11
<b>Radiation proctitis: a review.</b>
Babb RR Gastroenterology Division, Palo Alto Medical Clinic, California 94301, USA.[Record supplied by publisher]
Radiation therapy of cancers in the pelvic region may lead to radiation proctitis. Radiation injury to the rectal wall eventually causes connective tissue fibrosis and obliterative endarteritis with subsequent local tissue ischemia. Patients with radiation proctitis may be minimally ill and heal spontaneously. However, symptoms of proctitis may persist, and the disease progresses to chronic bleeding and/or stricture and fistula formation. Medical therapy is often unsuccessful, and surgery is eventually required. Because of numerous postoperative complications and no guarantee of success, surgery should only be done as a last resort. 
&&url PMID: 8677984


Radiographics 1996 Nov;16(6):1251-70; 
<b>Gastrointestinal tract involvement by gynecologic diseases.</b>
Szucs RA, Turner MA Department of Radiology, Medical College of Virginia Hospitals, Richmond 23298-0615, USA.[Record supplied by publisher]
Involvement of the gastrointestinal tract by gynecologic disease processes-endometriosis, gynecologic neoplasms, inflammatory processes, and complications from radiation therapy or surgery for gynecologic tumors-may mimic primary gastrointestinal carcinoma on radiologic images. .... Radiation colitis causes narrowing of the rectum with intact mucosa and can be differentiated from recurrent tumor, unlike radiation-induced injury of the small bowel, which may be difficult to distinguish. ...Familiarity with the varied patterns of gastrointestinal tract involvement is important for accurate interpretation of imaging studies. 
&&url PMID: 8946534


Am J Surg 1996 Oct;172(4):335-40 
<b>The ileocecal reservoir for rectal replacement in complicated radiation proctitis.</b> 
von Flue MO, Degen LP, Beglinger C, Harder FH. 
Department of Surgery, Kantonsspital, Basel University, Switzerland. 

Total rectal resection is the radical treatment method for radiation proctitis complications. Park's straight colo-anal reconstruction to replace the rectum often impairs anal continence, increases stool frequency, and causes imperative urgency. We developed and assessed a colo-anal reconstruction (ileocecal reservoir) after resection of radiation-damaged rectum. ... This rectal replacement technique permits good defecation quality and excellent anorectal function. 
&&url PMID: 8873525 


Urology 1996 Mar;47(3):387-94
<b>Effect of pelvic radiotherapy for prostate cancer on bowel, bladder, and sexual function: the patient's perspective.</b>
Crook J, Esche B, Futter N Department of Radiation Oncology, Ottawa Regional Cancer Centre, Canada. [Record supplied by publisher]

... A confidential questionnaire was distributed to 202 prostate cancer patients. ... The sequelae of pelvic radiotherapy as viewed from the patient's perspective reveal a major alteration in bowel function in 11%, significant bladder symptoms in 4%, and loss of potency in 35%. 
&&url PMID: 8633407



Br J Radiol 1996 Jun;69(822):548-54
<b>Incidence and possible aetiological factors in the development of pelvic insufficiency fractures following radical radiotherapy.</b>
Bliss P, Parsons CA, Blake PR Pelvic Unit, Royal Marsden Hospital, London. [Record supplied by publisher]
Five patients out of a total of 183 treated with radical radiotherapy for carcinoma of cervix at The Royal Marsden Hospital from 1991 to 1994 inclusive have developed severe pelvic fractures. ... We suggest that the presence of a connective tissue disorder in a patient with other risk factors such as steroid use, old age and osteopenia should alert the clinician to the risk of radionecrosis following radical irradiation. 
&&url PMID: 8757658


Radiol Med (Torino) 1995 May;89(5):643-6 
<b>[Ileal obstruction following radiosurgical treatment for rectosigmoid neoplasm].</b> [Article in Italian] 
Cerrotta A, Gardani G, Lozza L, Kenda R, Tana S, Valvo F, Zucali R Divisione di Radioterapia A, Istituto Nazionale per lo Studio e la Cura dei Tumori di Milano. [Record supplied by publisher] 

A series of 191 patients submitted to adjuvant radiotherapy after surgery for rectal and rectosigmoid carcinoma from January, 1975, to December, 1990, has been analyzed to evaluate the incidence of high grade small bowel late toxicity ....</b>Fourteen patients (7.3%) developed sequelae grades III/IV: three of them died of toxicity. Average free interval between radiation and complication was 23 months (range: 4-87). The following risk factors were investigated: sex, age, type of surgery on primary rectosigmoid cancer, previous abdominal or pelvic surgery, radiation technique, treated volume, administered radiation dose. .... The only factors significantly related to late intestinal complications were the beam arrangement and, consequently, the treated volume. Detailed analysis showed that radiation sequelae developed in 12/106 (11.3%) patients treated with the two sagittal fields technique, while small bowel toxicity was observed in only 2/85 (2.3%) patients treated with the three--or four--fields technique. The difference is statistically significant (p < 0.05). Another significant correlation was the ratio between treated volume and late complications incidence observed.</b>(ABSTRACT TRUNCATED AT 250 WORDS) 
&&url PMID: 7617904 


Clin Oncol (R Coll Radiol) 1995;7(2):123-6 
<b>Hip complications following chemoradiotherapy.</b> 
Jenkins PJ, Montefiore DJ, Arnott SJ. St Bartholomew's Hospital, London, UK. 
Chemoradiotherapy protocols are a recent development in the management of tumours where preservation of organ function is important. It is now recognized that such combined treatment may produce adverse effects below the accepted dose thresholds for either modality. This enhancement of toxicity is generally thought to reflect depletion of stem cells within the tissue concerned. We report four patients who have developed avascular necrosis or fractures of the hip following chemoradiotherapy for carcinoma of the vulva or anus. These complications developed after a radiation dose of 4500 cGy in 20 fractions. The possible role of cytotoxic agents in sensitizing bone to radiation damage is discussed, and a novel mechanism is proposed to account for this phenomenon. 
&&url PMID: 7619762 


Dis Colon Rectum 1994 Dec;37(12):1245-9 
<b>Clinicopathologic characteristics of large bowel cancer developing after radiotherapy for uterine cervical cancer.</b> 
Shirouzu K, Isomoto H, Morodomi T, Ogata Y, Araki Y, Kakegawa T. First Department of Surgery, Kurume University School of Medicine, Japan. 

... <b>[A retrospective chart review was performed] to clarify the characteristics of large bowel cancer developing after radiotherapy for uterine cervical cancer. ..:. 
The latent period was a mean of 20.5 years. The most common site was in the rectum (16/32). Mucin-producing carcinoma was observed in 53.1 percent, with an especially high rate of 75 percent in the rectum. Histologic radiation damage was also demonstrated at a high rate of 64.3 percent. C
 It was difficult to judge from clinicopathologic findings whether large bowel cancer developed with relation to radiation effect. We emphasize, however, that the characteristics are different from ordinary large bowel cancer. Particular consideration should be given to the high incidence of mucin-producing carcinoma.</b> 
&&url PMID: 7995152 

 
Abdom Imaging 1994 Nov-Dec;19(6):556-8 
<b>"Segmental" prolonged cortical nephrogram as a result of radiation damage to the kidneys.</b>
Older RA, Gay SB, Friday JM. Department of Radiology, University of Virginia Health Sciences Center, Charlottesville 22908. 
We present two cases showing bilateral segmental delayed nephrograms secondary to radiation injury which occurred during radiation therapy for retroperitoneal adenopathy... 
&&url PMID: 7820034


Jpn J Clin Oncol 1994 Oct;24(5):294-8 
<b>A case of radiation-induced rectal cancer developing after a long-term follow-up.</b> 
Shirouzu K, Isomoto H, Morodomi T, Ogata Y, Araki Y, Kakegawa T. First Department of Surgery, Kurume University School of Medicine, Fukuoka. 
... The time interval between the radiotherapy and the development of the rectal cancer was 19 years. .... Other radiation damage was additionally found including colitis, endarteritis and intestinal wall fibrosis.. 
&&url PMID: 7967109 


Strahlenther Onkol 1994 Aug;170(8):437-40 
<b>Radiation enteropathy.</b> 
Farthmann EH, Imdahl A, Eggstein S. Chirurgische Universitatsklinik Freiburg. 
PURPOSE: Radiation enteropathy presents a complex clinical picture which varies from case to case. Diagnosis and treatment require a thorough knowledge of the natural history of the condition and of the complications which are to be expected. ...: Haemorrhage, vomiting, diarrhoea and, occasionally, perforation are the signs of acute radiation enteropathy, which appears weeks or months after radiotherapy. Except for perforations, these can usually be treated conservatively. Chronic radiation enteropathy does not manifest itself until years after irradiation, with diarrhoea, obstruction and the development of fistulae. ..., many cases require operative intervention. This usually consists of resection, the establishment of a bypass anastomosis or enterostomy. In 44% of the patients postoperative complications followed, with a mortality of 22%. The cause of the high complication rate is partly the poor general condition of the patient, and partly the radiation induced impairment in wound healing, which may lead to insufficiency of the anastomosis and the development of fistulae. ...The treatment of radiation enteropathy is a demanding task. Because of the high complication rate, it is generally wise to choose the least risky procedure. 
&&url PMID: 8085209 

 
Cancer 1995 Feb 1;75(3):836-43 
<b>Ureteral stricture as a late complication of radiotherapy for stage IB carcinoma of the uterine cervix.</b> 
McIntyre JF, Eifel PJ, Levenback C, Oswald MJ Division of Radiotherapy, University of Texas, M. D. Anderson Cancer Center, Houston 77030. [Record supplied by publisher] 

...Ureteral stricture is a rare late complication of curative radiotherapy for carcinoma of the cervix. A retrospective study was performed to determine the incidence and latency of radiation-induced ureteral stricture, to investigate possible contributing factors, and to compare the time course and presenting characteristics of ureteral compromise caused by late radiation injury or tumor recurrence. .... <b>The overall incidences of severe ureteral stenosis were 1.0, 1.2, 2.2, and 2.5% at 5, 10, 15, and 20 years, respectively, reflecting a continuous actuarial risk increase of approximately 0.15% per year.</b> .... Patients who were treated with centrally blocked external fields or who received more than two transvaginal radiation treatments were at increased risk for developing ureteral stenosis. The risk was similar for patients treated with radiation alone or followed by extrafascial hysterectomy. 
...<b>During the first 5 years after treatment, tumor recurrence is the most common cause of ureteral stricture in patients treated with radiotherapy for carcinoma of the cervix. However, radiation injury to the ureter, although rare, may not become apparent for many years, necessitating continued vigilance throughout the lives of these patients.</b> 
&&url PMID: 7828135


Acta Chir Belg 1995;95(4 Suppl):190-4 
<b>Survival of patients with radiation enteritis of the small and the large intestine.</b> 
Libotte F, Autier P, Delmelle M, Gozy M, Pector JC, Van Houtte P, Gerard A Service of Oncologic Surgery, Institut Jules Bordet, Brussels, Belgiumx [Record supplied by publisher] 
We reviewed the clinical and survival data of 108 consecutive patients who presented with radiation enteritis between 1965 and 1981. One hundred and two (94%) had been irradiated for carcinoma of the cervix uteri. The median follow-up was of 11 years. The median time of occurrence of severe radiation-induced lesions (obstruction, perforation) after radiotherapy was of 18 months, against 10.5 months for mild symptoms (e.g., tenesmus) and 9 months for rectal bleeding (p < 0.001). Cox survival analysis taking into account the stage of the cancer and the age at diagnosis showed that rectal bleeding is a factor with a prognosis significantly poorer than the mild symptoms (p = 0.05), equivalent to that of the severe complications. We conclude that in the evaluation of patients who underwent radiotherapy for abdominal or pelvic tumours, <b>rectal bleeding should be considered as a sign of serious radiation-induced complication.</b> 
&&url PMID: 8779298 


Strahlenther Onkol 1994 Nov;170(11):675-6 
<b>[Vitamin B12 malabsorption following pelvic irradiation].</b> [Article in German] 
Dunst J [Record supplied by publisher] 
&&url PMID: 7974186 


Gynecol Oncol 1994 Apr;53(1):114-20 
<b>Small bowel obstruction following radical hysterectomy: risk factors, incidence, and operative findings.</b> 
Montz FJ, Holschneider CH, Solh S, Schuricht LC, Monk BJ Department of Obstetrics and Gynecology, UCLA Center for the Health Sciences 90024. [Record supplied by publisher] 

Three groups:  hysterectomy with: No radiation, preop radiation or postop radiation. 
... We concluded that small bowel obstructions due to intraperitoneal adhesions are frequent sequelae of radical hysterectomy, being more common if concomitant radiotherapy is given. 
&&url PMID: 8175009 


Rev Med Chil 1994 Jan;122(1):53-8 
<b>[Experience with the use of stomach in bladder reconstruction].</b> [Article in Spanish] 
Castillo O, Van Cauwelaert R, Azocar G, Aguirre C, Wholer C. Unidad de Urologia, Clinica Santa Maria, Santiago de Chile. 
Bladder reconstruction with a gastric portion, as an alternative to other intestinal segments, has gained popularity lately. We have used a vascularized gastric segment for bladder replacement in 20 patients aged 3 to 77 years old, between 1990 and 1993. The surgical indication was due to a severe radiation cystitis in 11 cases, ... 
&&url PMID: 8066345 


Gynecol Oncol 1993 Mar;48(3):328-32 
<b>Intraoperative radiation therapy in gynecologic cancer: the Mayo Clinic experience.</b> 
Garton GR, Gunderson LL, Webb MJ, Wilson TO, Martenson JA Jr, Cha SS, Podratz KC Division of Radiation Oncology, Mayo Clinic, Rochester, Minnesota 55905. [Record supplied by publisher] 

Nineteen patients with recurrent and two patients with locally advanced gynecologic malignancies received intraoperative radiation therapy (IORT) with electrons at the Mayo Clinic..., IORT in combination with maximum debulking surgery with or without external beam therapy in patients with paraaortic or pelvic sidewall recurrences of gynecologic malignancies appeared to improve long-term local control and survival. The addition of hyperthermia or hypoxic sensitizers may be a consideration to further improve local control in patients with gross residual disease. The high incidence of distant metastasis warrants the search for effective systemic chemotherapy. IORT-related toxicity was acceptable. 
&&url PMID: 8385058 


Anticancer Res 1993 Sep-Oct;13(5C):1877-81 
<b>Vitamin B12 malabsorption after irradiation for gynaecological tumours.</b> 
Snijders-Keilholz A, Griffioen G, Davelaar J, Trimbos JB, Leer JW. Department of Clinical Oncology, Leiden University Medical Centre, The Netherlands. 
... Ten patients (23%) were found to have decreased levels of serum vitamin B12, of which six (14%) were assumed to be caused by malabsorption due to radiation damage to the terminal ileum .... Neither the radiation dose or volume nor the manifestation of acute or late radiation side effects appeared to be correlated with the finding of decreased levels of vitamin B12. It is concluded that even in asymptomatic patients who received pelvic irradiation, serum vitamin B12 levels can serve as a marker for radiation enteropathy. <b>It is advocated to check vitamin B12 levels prior to the radiation treatment as well as during the follow-up of these patients.</b> 
&&url PMID: 8267396


Eur J Surg Oncol 1993 Aug;19(4):336-41 
<b>Surgical intervention for complications caused by late radiation damage of the small bowel: a retrospective analysis.</b> 
van Halteren HK, Gortzak E, Taal BG, Helmerhorst TJ, Aleman BM, Hart AA, Zoetmulder FA. Department of Surgery, Netherlands Cancer Institute, Amsterdam. 
We studied the records of 46 patients who had been operated on between 1974 and 1990 in The Netherlands Cancer Institute <b>because of complications due to late radiation damage of the small bowel. ... The following factors led to an increase in complication-risk: hypoalbuminemia, more than one laparotomy prior to irradiation and a short interval (< 12 months) between irradiation and surgical intervention. The following factors related to a poorer survival: incomplete resection of the primary tumor and a short interval (< 12 months) between irradiation and surgical intervention.</b> ... 
&&url PMID: 8359282 


Zentralbl Chir 1992;117(11):595-8 
<b>[Reversible fixation of the small intestine for minimizing radiation damage with polyglycolic acid mesh--initial experiences].</b> [Article in German] 
Arndt M, Pelster FW, Potter R. Abteilung Allgemein- und Gefasschirurgie, Chirurgischen Universitatsklinik Munster. 
.... No severe disturbance of bowel motility was seen. By sonographic and barium controls it could demonstrated that it was possible to keep the small intestine above the radiation fields as long as it was necessary for radiation treatment. After 3-4 months it could be demonstrated that the small bowel had descended into the pelvis again. 
&&url PMID: 1335198 


Radiat Res 1990 Sep;123(3):331-44 Erratum in: Radiat Res 1991 Dec;128(3):326 
<b>Cancer mortality following radium treatment for uterine bleeding.</b> 
Inskip PD, Monson RR, Wagoner JK, Stovall M, Davis FG, Kleinerman RA, Boice JD Jr. Department of Epidemiology, Harvard University School of Public Health, Boston, Massachusetts 02115. 

Cancer mortality in relation to radiation dose was evaluated among 4153 women treated with intrauterine radium (226Ra) capsules for benign gynecologic bleeding disorders between 1925 and 1965. Average follow up was 26.5 years (.... Overall, 2763 deaths were observed versus 2687 expected based on U.S. mortality rates [standardized mortality ratio (SMR) = 1.03]. Deaths due to cancer, however, were increased (SMR = 1.30), especially cancers of organs close to the radiation source. For organs receiving greater than 5 Gy, excess mortality of 100 to 110% was noted for cancers of the uterus and bladder 10 or more years following irradiation, while a deficit was seen for cancer of the cervix, one of the few malignancies not previously shown to be caused by ionizing radiation. Part of the excess of uterine cancer, however, may have been due to the underlying gynecologic disorders being treated. Among cancers of organs receiving average or local doses of 1 to 4 Gy, excesses of 30 to 100% were found for leukemia and cancers of the colon and genital organs other than uterus; no excess was seen for rectal or bone cancer. Among organs typically receiving 0.1 to 0.3 Gy, a deficit was recorded for cancers of the liver, gall bladder, and bile ducts combined, death due to stomach cancer occurred at close to the expected rate, a 30% excess was noted for kidney cancer (based on eight deaths), and there was a 60% excess of pancreatic cancer among 10-year survivors, but little evidence of dose-response. Estimates of the excess relative risk per Gray were 0.006 for uterus, 0.4 for other genital organs, 0.5 for colon, 0.2 for bladder, and 1.9 for leukemia. Contrary to findings for other populations treated by pelvic irradiation, a deficit of breast cancer was not observed (SMR = 1.0). Dose to the ovaries (median, 2.3 Gy) may have been insufficient to protect against breast cancer. <b>For organs receiving greater than 1 Gy, cancer mortality remained elevated for more than 30 years, supporting the notion that radiation damage persists for many years after exposure.</b> 
&&url PMID: 2217730 


Gynecol Oncol 1990 Jun;37(3):367-73 
<b>Randomized study of whole-abdomen irradiation versus pelvic irradiation plus cyclophosphamide in treatment of early ovarian cancer.</b> 
Sell A, Bertelsen K, Andersen JE, Stroyer I, Panduro J. Department of Oncology, Arhus University Hospital, Denmark. 

...118 patients ... ovarian cancer were randomized to abdominal irradiation or pelvic irradiation + cyclophosphamide. ... <b>Twenty-five percent of the patients treated with pelvic irradiation + cyclophosphamide had hemorrhagic cystitis, probably caused by radiation damage and cyclophosphamide cystitis. Eight percent had late gastrointestinal symptoms requiring surgery.</b> 
&&url PMID: 2351321 


Radiology 1990 Jun;175(3):805-13 
<b>Postirradiation changes in the pelvis: assessment with MR imaging.</b> 
Sugimura K, Carrington BM, Quivey JM, Hricak H. 
Department of Radiology, University of California, San Francisco 94143.
&&url PMID: 2343132 


Clin Radiol 1990 Mar;41(3):165-9 
<b>Radiological changes in the gastrointestinal and genitourinary tract following radiotherapy for carcinoma of the cervix.</b> 
Taylor PM, Johnson RJ, Eddleston B, Hunter RD. Department of Diagnostic Radiology, Christie Hospital and Holt Radium Institute, Withington, Manchester. 
&&url PMID: 2323163 


Strahlenther Onkol 1990 Apr;166(4):271-4Related Articles, Books, LinkOut 
<b>[Treatment of radiogenic colitis with a rectal foam containing cortisol. Clinical and pharmacologic data].</b> [Article in German] 
Szepesi S, Jacobi V, Vecsei P, Bottcher HD. Zentrum der Radiologie, Pharmakologisches Institut der Ruprecht-Karls-Universitat Heidelberg. 
the local therapy of Colifoam can be considered an additional treatment of radiation-induced colitis (proctitis). 
&&url PMID: 2330541 


J Clin Oncol 1989 Jun;7(6):718-24 
<b>Long-term follow-up of testicular function following radiation therapy for early-stage Hodgkin's disease.</b> 
Kinsella TJ, Trivette G, Rowland J, Sorace R, Miller R, Fraass B, Steinberg SM, Glatstein E, Sherins RJ. Department of Human Oncology, University of Wisconsin Clinical Cancer Center, Madison 53792. 
Seventeen male patients with pathological staged I-IIIA1 Hodgkin's disease were followed prospectively for radiation damage to the testes from low-dose scattered irradiation.... Radiation treatment techniques to shield the testes are discussed. 
&&url PMID: 2497228 

 
Patients with distant metastases were not given radiation. First results point to IORT providing lasting improvement of pancreatic pain. It is too early to know whether survival time is favourably influenced.  
&&url PMID: 2423312


Eur J Gynaecol Oncol 1989;10(5):302-7 
<b>Results of radiotherapy of cervix cancer stage IB depending on the techniques of intracavitary gamma-therapy.</b> 
Vishnevskaya EE. Scientific Research Inst. of Oncology and Medical Radiology of the BSSR Health Ministry, USSR. 

.... The frequency of radiation damage was found by investigation to depend on the variant of gamma-therapy used. Radiation reactions in the course of treatment and after its completion were most frequent in patients irradiated by traditional intracavitary technique.. 
&&url PMID: 2806316 


Gynecol Oncol 1988 May;30(1):15-20 Erratum in: Gynecol Oncol 1988 Oct;31(2):369 
<b>Salvage radiotherapy for carcinoma of the ovary following chemotherapy.</b> 
Cheung AY. Department of Radiation Oncology, University of Western Ontario, London, Canada. 
&&url PMID: 3366392


Dis Colon Rectum 1987 Dec;30(12):953-8 
<b>Colon and anorectal cancer after pelvic irradiation.</b> 
Jao SW, Beart RW Jr, Reiman HM, Gunderson LL, Ilstrup DM. Section of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota. 
Seventy-six cases of colon or anorectal cancer after pelvic irradiation for other malignant or benign lesions were reviewed. ... percent had received irradiation for gynecologic malignancy. The cancer developed at a mean of 15.2 years after irradiation (peak frequency between five and ten years); 85 percent of the patients had a mild to prominent radiation reaction around the cancer. ... only 17 percent of patients presented with symptoms of radiation proctitis, and the mean radiation dosages were not high. High radiation dosage and severe radiation damage may not be essential for radiation-associated colorectal cancer. The overall five-year survival rate was 48 percent. Close surveillance of the colon and anorectal regions of these high-risk patients at five years after irradiation is indicated. 
&&url PMID: 3691269 


Eur J Surg Oncol 1987 Feb;13(1):21-5 
<b>Rectal carcinoma: a new technique to allow safer postoperative irradiation of the pelvis.</b> 
Allen PI, Fielding JW, Middleton MD, Priestman TJ. 
... This paper describes a simple and quick method of excluding the small bowel from the pelvis which, combined with more sophisticated radiation field planning, could dramatically reduce the incidence of enteric effects. 
&&url PMID: 3545905 

 
Dtsch Med Wochenschr 1986 Jun 6;111(23):892-6 
<b>[Intraoperative radiation treatment of carcinoma of the pancreas. Initial clinical results].</b>[Article in German] 
Bodner E, Glaser K, Aufschnaiter M, Kohle W, Url M, Frommhold H. 
Intraoperative radiotherapy (IORT) was administered to 13 patients with carcinoma of the pancreas, using high-velocity electrons of a LINAC accelerator in a single dose of maximally 25 Gy applied directly to the tumour or tumour bed with the abdomen open. There were no disorders of wound healing or other serious early complications which could be ascribed to the radiation. Stomach and intestines were excluded from the radiation field to avoid late radiation damage, such as stenoses or ulcers. The method is particularly indicated for locally non-resectable, non-metastasized pancreatic carcinoma, possibly also as tumour-bed radiation during radical surgery.


J Surg Oncol 1987 Oct;36(2):93-7 
<b>Surgical treatment of intestinal radiation injury.</b> 
Makela J, Nevasaari K, Kairaluoma MI. Department of Surgery, Oulu University Central Hospital, Finland. 

...<b>The overall operative mortality was 14%; morbidity, 47%;</b> ... Colostomy (N = 20) carried the lowest risk of mortality, 0%, as compared with resection (N = 17) and bypass procedure (N = 6), which were accompanied by the mortalities of 24% and 33%, respectively. During the follow-up (3-13 years) 12 patients (28%) died of recurrent cancer and 9 patients (21%) of persistent radiation injury, <b>which yielded an overall mortality of 65% after resection and 50% and 65% after bypass and colostomy procedures, respectively. Continuing radiation damage led to 15 late reoperations.</b> Ten of these were performed after colostomy, four after resection, and one after bypass. We conclude that colostomy cannot be regarded as a preferred operative method, because it does not prevent the progression of radiation injury and because it is, for this reason, associated with a higher late-complication rate. A more radical surgery is recommended but with the limitation that the operative method must be adapted to the operative finding. 
&&url PMID: 3657181 

 
<b>The endoscopic spectrum of late radiation damage of the rectosigmoid colon.</b> 
den Hartog Jager FC, van Haastert M, Batterman JJ, Tytgat GN. 
The endoscopic spectrum of late radiation damage to the rectosigmoid colon in 90 patients seen over a 10 year period (1973-1983) is presented. The main endoscopic findings were abnormalities of the mucosa with characteristic telangiectasis, luminal narrowing, superficial or deep solitary ulcers or more extensive diffuse ulceration and fistulae. A knowledge of the pathognomonic features may lead to early detection and treatment. 
&&url PMID: 4065051 


Histopathology 1985 May;9(5):517-34 
<b>Vascular changes in radiation bowel disease.</b> 
Hasleton PS, Carr N, Schofield PF. 

A series of 20 cases of radiation bowel disease (RBD) was studied qualitatively and the arterial changes were studied quantitatively. A control series of 45 cases was studied. In the control cases there were positive correlations between the medial thickness of all vessels studied and the diastolic blood pressure as well as the incidence of intimal fibrosis in both intramural and extramural arteries. <b>The medial thickness in all the arteries in cases of RBD was significantly higher than in the controls. This was probably due to the large number of fibrin thrombi which increased the vascular resistance. The degree of intimal fibrosis of the intramural arteries and arterioles was significantly greater than in the controls. Similarly the incidence of intimal fibrosis in all arterioles and intramural arteries was greater than the control group. The degree of intimal fibrosis was related to the dose of radiation received. The effect of radiation was an on-going process since the percentage of arterioles with intimal fibrosis increased with the time after radiotherapy. Blood pressure and age played no part in these correlations in RBD. The most consistently observed qualitative changes in RBD were in the arteries, arterioles and to a lesser extent the veins. These showed fibrin thrombi, fibrinoid necrosis, subendothelial oedema and fibrin. Various stages of healing were seen in the vessels. We believe that the blood vessels are the main site of injury in RBD and that the endothelial cell is the initial target for radiation damage.</b> 
&&url PMID: 4007790 


Int J Radiat Oncol Biol Phys 1983 Oct;9(10):1445-50Related Articles, Books, LinkOut 
<b>The relationship between early and late gastrointestinal complications of radiation therapy for carcinoma of the cervix.</b> 
Bourne RG, Kearsley JH, Grove WD, Roberts SJ. 
In a retrospective analysis of 1,390 consecutive patients with carcinoma of the cervix treated by high dose radiation therapy alone at the Queensland Radium Institute, we report a quantitative relationship between the early and late gastrointestinal complications arising from such treatment. Of these 1,390 patients, 157 (11.3%) experienced early, serious complications. For geographic reasons, it was only possible to evaluate 784 patients for late post-irradiation complications. Twenty-eight (3.6%) developed one or more late bowel complications, which included adhesions, fistulae, strictures, perforation, colitis and vascular occlusion. Factors affecting the relative risk of developing either an early or late complication were analyzed and are discussed. There was an 8.2% incidence of late complications developing in those patients who had experienced early complications, compared with a 3.0% incidence of late complications developing in patients without early complications. Thus, the risk of developing a late complication was greater by a factor of 2.7 in those patients developing an early one (p less than 0.05). However, of the 28 patients developing late complications, 21 (75%) did not experience a severe acute one. 
&&url PMID: 6415005  


Br J Surg 1981 Jul;68(7):488-92 
<b>The surgical treatment of the radiation-damaged rectum.</b> 
Cooke SA, de Moor NG. 
Details are given of 37 consecutive patients with radiation damage to the rectum. Twenty-eight presented with rectovaginal fistulas, 3 with haemorrhage from ulcerative proctitis, 3 with low rectal strictures, 2 with a painful rectal ulcer and 1 with a rectal carcinoma. Thirty-five of the 37 had been treated for carcinoma of the cervix, and of these, 30 were Black South African women in whom this disease forms approximately 70 per cent of all malignancies. Associated pathology in these patients included urinary fistulas, small bowel fistulas or stenoses and a variable degree of fibrosis of the pelvic cellular tissue. Treatment involved subtotal rectal resection with restoration of continuity by means of a peranal sleeve anastomosis between healthy colon and the rectal stump denuded of its mucosa. Technical success was achieved in 35 of the 37 patients, with no mortality. The functional results were assessed both subjectively and objectively in 31 patients followed up for more than 6 months. Full continence was achieved in 54 per cent initially, improving to 75 per cent (21 of 28) at 1 year postoperatively. At 1 year, variable degrees of incontinence for a liquid stool persisted in 7 of 9 patients who had low fistulas with a low anastomosis at dentate line level. Where anastomosis was possible at a higher level, all 19 patients cured of fistula, ulcer, stenosis or haemorrhagic proctitis were fully continent at 1 year. 
&&url PMID: 7248720


Eur Urol 1981;7(2):115-7 
<b>Kidney damage by ionizing radiation.</b> 
Kosters S, Birzele H, Hienz HA, Baumbusch F. 
The report describes a case of radiation damage to a kidney due to radiotherapy of a sarcoma of the muscles of the back. The characteristic clinical, pathological and histological findings and the results of X-ray investigation are presented in detail. 
&&url PMID: 7461003 

 
Br J Surg 1981 Jan;68(1):25-8 
<b>Chylous ascites and obstructive lymphoedema of the small bowel following abdominal radiotherapy.</b> 
Hurst PA, Edwards JM. 
The case history of a patient who developed chylous ascites following abdominal irradiation for recurrent carcinoma of the colon is presented. Laparotomy revealed generalized radiation damage of the small bowel with a particularly severely affected segment of jejunum, from the serosal surface of which chyle was seen to be leaking. Mesenteric lymphangiography revealed an obstruction to lymphatic drainage in the mesentery. Resection of the worst affected segment of bowel prevented further development of chylous ascites. 
&&url PMID: 519163 


Radiology 1979 Aug;132(2):479-82 
<b>Factors predisposing to radiation-related small-bowel damage.</b> 
Potish RA, Jones TK Jr, Levitt SH. 
From 1970 through 1977, 92 patients with ovarian cancer received 20 Gy (2,000 rad) to the abdomen, followed by 30 Gy (3,000 rad) to the pelvis. Small-bowel obstruction developed in 7 (7.6%). The number of previous laparotomies, thin physique, and hypertension were significantly associated with complications. Two patients receiving isoniazid and 2 receiving Premarin had enteric complications. Pre-existing vascular damage may potentiate radiation damage to the small bowel. 
&&url PMID: 461811 [PubMed


South Med J 1978 Aug;71(8):960-1 
<b>Radiation-recall enteritis after actinomycin-D and adriamycin therapy.</b> 
Stein RS. 
A 22-year-old man developed four episodes of bowel obstruction after radiation therapy for a testicular tumor metastatic to retroperitoneal nodes. Each episode followed a course of chemotherapy with actinomycin-D or adriamycin. On one occasion bowel resection was required and revealed vascular changes compatible with radiation injury. The case appears to be an example of radiation recall injury involving the small bowel. The decision to use actinomycin-D or adriamycin must be weighed against the risk of tissue injury when a predisposition to radiation damage is present. 
&&url PMID: 684478