Abstract
Radiotherapy is one of the main therapeutic methods for treating cancer. The digestive system consists of the gastrointestinal tract and the accessory organs of digestion (the tongue, salivary glands, pancreas, liver and gallbladder). The digestive system is easily impaired during radiotherapy, especially in thoracic and abdominal radiotherapy. In this review, we introduce the physical classification, basic pathogenesis, clinical characteristics, predictive/diagnostic factors, and possible treatment targets of radiotherapy-induced digestive injury. Radiotherapy-induced digestive injury complies with the dose-volume effect and has a radiation-based organ correlation. Computed tomography (CT), MRI (magnetic resonance imaging), ultrasound (US) and endoscopy can help diagnose and evaluate the radiation-induced lesion level. The latest treatment approaches include improvement in radiotherapy (such as shielding, hydrogel spacers and dose distribution), stem cell transplantation and drug administration. Gut microbiota modulation may become a novel approach to relieving radiogenic gastrointestinal syndrome. Finally, we summarized the possible mechanisms involved in treatment, but they remain varied. Radionuclide-labeled targeting molecules (RLTMs) are promising for more precise radiotherapy. These advances contribute to our understanding of the assessment and treatment of radiation-induced digestive injury.
Highlights
Cancer is one of the greatest health problems in the 21st century
Radiation-induced digestive injuries during radiotherapy can be divided into two categories: salivary gland injury and digestive tract injury
Radiation damage derives from hyposalivation, followed by xerostomia, mucositis, nutritional deficiencies, oral infections, and functional changes
Summary
Cancer is one of the greatest health problems in the 21st century. Approximately 29.8% of premature deaths (4.5 billion out of 15.2 billion) are attributed to cancer, ranking first or second in 134 of 183 countries [1]. Radiotherapy, along with chemotherapy and surgery, is one of the three core methods of treating cancer. Food is chewed by the oral cavity into small pieces and mixed with saliva, forming a bolus that passes through the esophagus into the stomach. After the chyme passes into the small intestine, the pancreas secretes various digestive enzymes through the pancreatic bile tract, while the gallbladder releases bile secreted by the liver that breaks down nutrients into molecules to be absorbed in the small intestine. Radiation-induced digestive injury is defined as acute or chronic lesions caused by ionizing radiation in the digestive organs, including the oral cavity, salivary glands, esophagus, stomach, intestines and anus. Radiotherapy, as one of the main methods of cancer treatment, accounts for almost all digestive injuries [4]. The digestive system, as one of the most sensitive physiological organs to radiation therapy, usually suffers the most severe side effects from radiotherapy [4]
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