Late gastrointestinal complications of radiation therapy have been recognized but not extensively studied. In this paper, the late effects of radiation on three gastrointestinal sites, the esophagus, the stomach, and the bowel, are described. Esophageal dysmotility and benign stricture following esophageal irradiation are predominantly a result of damage to the esophageal wall, although mucosal ulcerations also may persist following high-dose radiation. The major late morbidity following gastric irradiation is gastric ulceration caused by mucosal destruction. Late radiation injury to the bowel, which may result in bleeding, frequency, fistula formation, and, particularly in small bowel, obstruction, is caused by damage to the entire thickness of the bowel wall, and predisposing factors have been identified. For each site a description of the pathogenesis, clinical findings, and present management is offered. Simple and reproducible endpoint scales for late toxicity measurement were developed and are presented for each of the three gastrointestinal organs. Factors important in analyzing late complications and future considerations in evaluation and management of radiation-related gastrointestinal injury are discussed.

Late effects of radiation therapy on the gastrointestinal tract.

The nutritional status of a cancer patient may be affected by the tumor, the chemotherapy and/or radiation therapy directed against the tumor, and by complications associated with that therapy. Chemotherapy-radiotherapy is not confined exclusively to malignant cell populations; thus, normal tissues may also be affected by the therapy and may contribute to specific nutritional problems. Impaired nutrition due to anorexia, mucositis, nausea, vomiting, and diarrhea may be dependent upon the specific chemotherapeutic agent, dose, or schedule utilized. Similar side effects from radiation therapy depend upon the dose, fractionation, and volume irradiated. When combined modality treatment is given the nutritional consequences may be magnified. Prospective, randomized clinical trials are underway to investigate the efficacy of nutritional support during chemotherapy-radiotherapy on tolerance to treatment, complications from treatment, and response rates to treatment. Preliminary results demonstrate that the administration of total parenteral nutrition is successful in maintaining weight during radiation therapy and chemotherapy, but that weight loss occurs after discontinuation of nutritional support. Thus, long-term evaluation is mandatory to learn the impact of nutritional support on survival, disease-free survival, and complication rates, as well as on the possible prevention of morbidity associated with aggressive chemotherapy-radiation therapy.

Alterations of nutritional status. Impact of chemotherapy and radiation therapy

Vascular and endovascular surgery : a comprehensive review

Patients with malignancies which are treated with therapeutic radiation are at risk for nutritional problems, both from their underlying malignancy as well as from their treatment. These effects may be acute or chronic and relate to the site of the tumor and regions irradiated. There is a large experience with nutritional intervention in irradiated patients, including oral feedings and enteral and parenteral nutritional support. The indications for the specific administration of nutritional support during radiotherapy depend on the nutritional status of the patient and the area irradiated, as well as the individual prognosis. Patients who are malnourished at the time of treatment are most likely to profit from nutritional intervention. To date, prospective randomized trials of nutritional support in patients undergoing radiotherapy fail to show a benefit of routine adjuvant nutritional intervention in terms of improved response and tolerance to treatment, improved local control or survival rates, or reduction of complications from therapy.

Nutritional support as an adjunct to radiation therapy.

ALTHOUGH ligation of the inferior vena cava for prevention of pulmonary emboli is being performed increasingly often a difference of opinion still exists regarding the choice between inferior-vena-cava ligation, femoral-vein ligation and anticoagulation. In addition, the advisability of inferior-vena-cava ligation in critically ill patients and specifically in symptomatic cardiac patients is open to question.1 , 2 Lastly, the degree of late sequelae that may be expected in the lower extremities after ligation of the inferior vena cava is not completely clear from the existing published reports.1 2 3 4 5 6 7 8 9 If one assumes that every pulmonary embolism is potentially fatal the choice of therapy for . . .

Reassessment of the Role of Inferior-Vena-Cava Ligation in Venous Thromboembolism

Late results of inferior vena cava ligation.

Surgery in radiation injury of the stomach.

The dumping syndrome after gastroenterostomy.

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Late results of inferior vena cava ligation.

Surgery in radiation injury of the stomach.

The dumping syndrome after gastroenterostomy.