Radiation intestinal injury in the era of precision radiotherapy

Abstract

Radiation-induced intestinal injury is caused by radiotherapy of pelvic malignant tumors. The main symptoms include persistent blood in stool, tenesmus, perianal pain, and severe intestinal perforation. Compared to conventional radiotherapy, precision radiotherapy (PT) has a greater advantage in the protection of normal tissues by reducing radiation dose of intestinal tract. However, in the era of PT, we still need to face the balance between curative effect and side injury, especially for complex, recurrent or advanced tumors. In general, when making treatment decisions, we should give priority to radiotherapeutic efficacy and patient survival, then consider how to reduce radiotherapy injuries. Decision-making requires multidisciplinary team consultation, together with patients and their families. Due to the difficulty and complexity in the treatment of radiation-induced intestinal injury, its prevention is very important. PT is advised, including avoiding excessive intestinal doses, and controlling the irradiation area of the mucosa. Constipation prevention is important during and after radiotherapy, in order to avoid damage to the intestine. Diet education is necessary. Patient should not eat leftovers, cold dishes, pickles and other foods prone to cause intestinal infections. At present, there are still few researches in the field of radiation-induced intestinal injury. We expect that in the near future, there will be greater progress and breakthroughs in prevention, diagnosis and treatment of radiation-induced intestinal injury.