Abstract
Radiation therapy of most malignant tumors requires dose-fractionation regimens near the tolerance of the surrounding normal tissues. With the exception of the bone marrow and the lung in which the morbidity may be minimized by reducing the volume irradiated, other structures require limitations of total doses to minimize adverse effects. In thoracic irradiation, the most sensitive normal structure is the lung, while the heart and esophagus do not frequently have serious late effects. Pelvic irradiation carries a much greater risk of morbidity, primarily to the fixed segments of small bowel and less frequently to the large bowel and bladder. Irradiation of the upper aerodigestive tract may be complicated by necrosis of soft tissues and bone, especially the mandible. Dental management greatly affects the risk of complications. Bones and soft tissues elsewhere in the body are rarely affected except in the growing child. The normal pituitary may be irradiated when tumors near the base of the skull are treated. The production of growth hormone may especially be compromised in children. Acute, subacute, and late effects of irradiation of the brain are well recognized. While transient radiation myelopathy is frequent and not serious, progressive radiation myelopathy is rare but extremely grave. Host factors, other diseases, and technical aspects of radiation therapy affect the risks and severity of adverse effects on normal tissues. Surgical procedures may be important in preventing complications as well as in managing them.
Résumé
L'irradiation de la majorité des tumeurs malignes implique le fractionnement des doses susceptibles d'Être tolérées par les tissus normaux voisins. A l'exception de la moelle osseuse et du poumon dont la morbidité après irradiation peut Être diminuée en réduisant le volume irradié, les autres structures anatomiques imposent de limiter les doses de manière à réduire les effets secondaires. Au niveau du thorax, le poumon est particulièrement sensible à l'irradiation alors que l'oesophage et le coeur le sont moins. L'irradiation pelvienne comporte de plus grands risques de morbidité en particulier en ce qui concerne l'intestin grÊle et moins souvent en ce qui concerne le colon et la vessie. L'irradiation de la partie supérieure de l'appareil aéro-digestif peut Être suivie de la nécrose des parties molles et du squelette spécialement du maxillaire. Le traitement des affections dentaires implique un risque indubitable de complications. En revanche les os et les parties molles des autres parties du corps sont moins sensibles, sauf chez l'enfant. L'hypophyse peut Être irradiée lors du traitement des tumeurs situées au niveau de la base du crane. La production de l'hormone de croissance peut Être compromise quand l'irradiation est pratiquée chez l'enfant. Les effets immédiats secondaires et tardifs de l'irradiation du cerveau sont bien connus. Alors que la myélopathie fugace secondaire à l'irradiation est fréquente et peu grave, la forme progressive est rare mais extrÊmement sévère. Les facteurs propres au malade, les autres maladies, les conditions techniques de l'irradiation ne sont pas sans affecter les risques et la gravité des effets secondaires sur les tissus normaux. Les méthodes chirurgicales pour prévenir ces complications ou les traiter revÊtent une grande importance.
Resumen
La terapia de irradiación para la mayoría de los tumores malignos requiere regimenes de fraccionamiento de la dosis cercanos a la tolerancia de los tejidos vecinos normales. Con excepción de la medula ósea y del pulmón, donde la morbilidad puede ser minimizada reduciendo el volumen irradiado, otras estructuras exigen la limitación de la dosis total para minimizar los efectos adversos. En la irradiación torácica la estructura más sensible es el pulmón, en tanto que el corazón y el esófago frecuentemente exhiben efectos tardíos. La irradiación pélvica conlleva un riesgo mucho más alto de morbilidad, primordialmente a cargo de los segmentos fijos de intestino, y con menos frecuencia a cargo del intestino grueso y de la vejiga. La irradiación del tracto aerodigestivo superior puede complicarse por necrosis de los tejidos blandos y del hueso, especialmente de la mandíbula. El manejo dental afecta en forma importante el riesgo de complicaciones. Los huesos y los tejidos blandos en otras regiones del cuerpo rara vez se ven afectados, excepto en los niños en crecimiento. La pituitaria puede resultar irradiada en el curso del tratamiento de tumores cerca de la base del cráneo. La producción de hormona del crecimiento puede verse especialmente comprometida en los niños. Los efectos agudos, subagudos y tardios de la irradiación del cerebro son bien conocidos. En tanto que la mielopatía transitoria de irradiación es frecuente y no grave, la mielopatía progresiva de irradiación es rara pero extremadamente grave. Factores relativos al huésped, otras enfermedades, los aspectos técnicos de la radioterapia, son factores que afectan los riesgos y la severidad de los efectos adversos sobre los tejidos normales. Los procedimientos quirÚrgicos pueden ser importantes en la prevención de las complicaciones así como en el manejo de ellas.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Moss, W.T., Brand, W.N., Battifora, H.: Radiation Oncology: Rationale, Technique, Results, 5th edition. St. Louis, C.V. Mosby Co., 1979
Hall, E.J.: Radiobiology for the radiologist, 2nd edition. New York, Harper and Row, 1978
Rubin, P., Casarett, G.W.: Clinical Radiation Pathology, vols. I and II. Philadelphia, W.B. Saunders Co., 1968
Rubin, P.: The Franz Buschke Lecture: Late effects of chemotherapy and radiation therapy: A new hypothesis. Int. J. Radiat. Oncol. Biol. Phys.10:5, 1984
Van Dyk, J., Keane, T.J., Kan, S., Rider, W.D., Fryer, C.J.H.: Radiation pneumonitis following large single dose irradiation: A re-evaluation based on absolute dose to lung. Int. J. Radiat. Oncol. Biol. Phys.7:461, 1981
Fryer, C.J.H., Fitzpatrick, P.J., Rider, W.D., Poon, P.: Radiation pneumonitis: Experience following a large single dose of radiation. Int. J. Radiat. Oncol. Biol. Phys.4:931, 1978
Bortin, M.N., Kay, H.E.M., Gale, R.P., Rimm, A.A.: Factors associated with interstitial pneumonitis after bone marrow transplantation for acute leukemia. Lancet1:437, 1982
Wara, W.M., Phillips, T.L., Margolis, L.W., Smith, V.: Radiation pneumonitis: A new approach to the derivation of time-dose factors. Cancer32:547, 1973
Phillips, T.L., Margolis, L.: Radiation pathology and the clinical response of lung and esophagus. In Frontiers of Radiation Therapy and Oncology, vol. 6, Radiation Effects and Tolerance, Normal Tissue, J.M. Vaeth, editor. Baltimore, University Park Press, 1972, pp. 254–273
Travis, E.L.: The sequence of histological changes in mouse lungs after single doses of x-rays. Int. J. Radiat. Oncol. Biol. Phys.6:345, 1980
Penney, D.P., Rubin, P.: Specific early fine structural changes in lung following irradiation. Int. J. Radiat. Oncol. Biol. Phys.2:1123, 1977
Moosavi, H., McDonald, S., Rubin, P., Cooper, R., Stuard, I.D., Penney, D.P.: Early radiation dose response in lung: An ultrastructural study. Int. J. Radiat. Oncol. Biol. Phys.2:921, 1977
Travis, E.L., Harley, R.A., Fenn, J.O., Klobukowski, C.J., Hargrove, H.B.: Pathologic changes in the lung following single and multiple fraction irradiation. Int. J. Radiat. Oncol. Biol. Phys.2:475, 1977
Rubin, P., Shapiro, D.L., Finkelstein, J.N., Penney, D.P.: The early release of surfactant following lung irradiation of alveolar type II cells. Int. J. Radiat. Oncol. Biol. Phys.6:75, 1980
Rubin, P., Siemann, D.W., Shapiro, D.L., Finkelstein, J.N., Penney, D.P.: Surfactant release as a measure of radiation pneumonitis. Int. J. Radiat. Oncol. Biol. Phys.9:1669, 1983
Prato, F.S., Kurdyak, R., Saibil, E.A., Rider, W.D., Aspin, N.: Physiological and radiographic assessment during the development of pulmonary radiation fibrosis. Radiology122:389, 1977
Hagen, S., Kolbenstvedt, A.: Radiologic pulmonary changes following cobalt 60 treatment of mammary carcinoma. Acta Radiol. Ther.11:386, 1972
Lokich, J.J., Bass, H., Eberly, F.E., Rosenthal, D.S., Moloney, W.C.: The pulmonary effect of mantle irradiation in patients with Hodgkin's disease. Radiology108:397, 1973
Kaplan, H.S., Stewart, J.R.: Complication of intensive megavoltage radiotherapy for Hodgkin's disease. Natl. Cancer Inst. Monogr.36:439, 1973
Meyer, J.E.: Thoracic effects of therapeutic irradiation for breast carcinoma. Am. J. Roentgenol.108:397, 1973
Seydel, H.G., Maun, J.: Pulmonary fibrosis following radiotherapy for bronchogenic carcinoma and Hodgkin's disease. Md. State Med. J.18:61, 1969
Host, H., Vale, J.R.: Lung function after mantle field irradiation in Hodgkin's disease. Cancer32:328, 1973
Bennett, D.E., Million, R.R., Ackerman, L.V.: Bilateral radiation pneumonitis, a complication of the radiotherapy of bronchogenic carcinoma (report and analysis of seven cases with autopsy). Cancer23:1001, 1969
Berdjis, C.C.: Cortisone and irradiation. Dis. Chest37:621, 1960
Castellino, R.A., Glatstein, E., Turbow, M.D., Rosenberg, S., Kaplan, H.S.: Latent radiation injury of the heart or lung activated by steroid withdrawal. Ann. Intern. Med.80:593, 1974
Moss, W.T., Haddy, F.J., Sweany, S.K.: Some factors altering the severity of acute radiation pneumonitis, variation with cortisone, heparin, and antibiotics. Radiology75:50, 1960
Roswit, B., White, D.C.: Severe radiation in injuries of the lung. Am. J. Roentgenol.129:127, 1977
Germon, P.A., Brady, L.W.: Physiologic changes before and after radiation treatment for carcinoma of the lung. J.A.M.A.206:809, 1968
Gross, N.J.: Pulmonary effects of radiation therapy. Ann. Intern. Med.86:81, 1977
Evans, R.F., Sagerman, R.H., Ringrose, T.L., Auchincloss, J.H., Bowman, J.: Pulmonary function following mantle field irradiation for Hodgkin's disease. Radiology111:729, 1974
Libshitz, H.I., Shuman, L.S.: Radiation induced pulmonary change: CT findings. J. Comput. Assist. Tomogr.8:15, 1984
Van Dyk, J., Hill, R.P.: Postirradiation lung density changes measured by computerized tomography. Int. J. Radiat. Oncol. Biol. Phys.9:847, 1983
Einhorn, L., Krause, M., Hornback, N., Furnas, B.: Enhanced pulmonary toxicity with bleomycin and radiotherapy in oat cell lung cancer. Cancer37:2414, 1976
Green, N., Weinstein, H.: Reassessment of radiation therapy for the management of lung cancer in patients with chronic pulmonary disease. Int. J. Radiat. Oncol. Biol. Phys.9:1891, 1983
Brosius, F.C., Waller, B.F., Roberts, W.C.: Radiation heart disease: Analysis of 16 young (aged 15–33 years) necropsy patients who received over 3500 rads to the heart. Am. J. Med.70:519, 1981
McReynolds, R.A., Gold, G.L., Roberts, W.C.: Coronary heart disease after mediastinal irradiation for Hodgkin's disease. Am. J. Med.60:39, 1976
Dollinger, M.R., Lavine, D.M., Foye, L.V., Jr.: Myocardial infarction due to post-irradiation fibrosis of the coronary arteries: Case of successfully treated Hodgkin's disease with lower esophageal involvement. J.A.M.A.195:316, 1966
Kaplan, H.S.: Hodgkin's Disease. Cambridge, Mass., Harvard University Press, 1980
Ruckdeschel, J.C., Chang, P., Martin, R.G., Byhardt, R.W., O'Connell, M.J., Sutherland, J.C., Wiernik, P.H.: Radiation related pericardial effusions in patients with Hodgkin's disease. Medicine54:245, 1975
Dana, M., Colombel, P., Bayle-Weisgerber, G., Tiellet, F., Desperez-Curely, J.P., Bernard, J., Chotin, G.: Pericarditis after wide field mediastinal irradiation for Hodgkin's disease. J. Radiol. Electrol. Med. Nucl.59:335, 1978
Stewart, J.R., Fajardo, L.F.: Radiation induced heart disease. Radiol. Clin. North Am.9:511, 1971
Cohn, K.J.E., Stewart, J.R., Fajardo, L.F., Hancock, E.W.: Heart disease following radiation. Medicine46:281, 1967
Byhardt, R.W., Brace, K., Ruckdeschel, J.C., Chang, P., Martin, R.G., Wiernik, P.H.: Dose and treatment factors in radiation related pericardial effusion associated with a mantle technique for Hodgkin's disease. Cancer35:795, 1975
Gomez, G.A., Park, J.J., Panahon, A.M., Parthasarathy, K.L., Pearce, J., Reese, P., Bakshi, S., Henderson, E.S.: Heart size and function after radiation therapy to the mediastinum in patients with Hodgkin's disease. Cancer Treat. Rep.67:1099, 1983
Wehr, M., Rosskopf, B.G., Pittner, P.M., Schwenk, D., Prignitz, R.: The effect of radiation therapy on the heart in patients with left-sided mammary carcinoma. International Association for Breast Cancer Research, March 20–24, 1983, Denver, Colorado. Int. Assoc. Breast Cancer Research, 1983, p. A23
Gottdiener, J.S., Katin, M.J., Borer, J.S., Bacharach, S.L., Green, M.V.: Late cardiac effects of therapeutic mediastinal irradiation: Assessment by echocardiography and radionuclide angiography. N. Engl. J. Med.308:569, 1983
Applefeld, M.M., Cole, J.F., Pollock, S.H., Sutton, F.J., Slawson, R.G., Singleton, R.T., Wiernik, P.N.: The late appearance of chronic pericardial disease in patients treated by radiation therapy for Hodgkin's disease. Ann. Intern. Med.94:338, 1981
Mill, W.B., Baglan, R.J., Kurichety, P., Prasad, S., Lee, J.Y., Moller, R.: Symptomatic radiation induced pericarditis in Hodgkin's disease. Int. J. Radiat. Oncol. Biol. Phys.10:2061, 1984
Miller, A.J.: Some observations concerning pericardial effusions and the relationship to the venous and lymphatic circulation of the heart. Lymphology2:76, 1970
Poussin-Rosillo, H., Nisce, L.Z., Lee, B.J.: Complications of total nodal irradiation of Hodkin's disease, stages III and IV. Cancer42:437, 1978
Morton, D.L., Glancy, D.O., Joseph, W.L.: Management of patients with radiation induced pericarditis with effusion. Chest64:291, 1973
Steinberg, I.: Effusive constrictive pericarditis. Am. J. Cardiol.19:434, 1967
Rubin, P., Casarett, G.W.: Clinical Radiation Pathology. Philadelphia, W.B. Saunders Co., 1968, pp. 153–192
Roswit, B.: Complications of radiation therapy: The alimentary tract. Semin. Roentgenol.9:51, 1974
Seaman, W.B., Ackerman, L.V.: The effect of radiation on the esophagus. Radiology68:534, 1957
Morichau-Beauchant, M., Touchard, G., Battandier, D., Maire, P., Fontanel, J.P., Daban, A., Babin, P., Matuchansky, C.: Chronic radiationinduced esophagitis after treatment of oropharyngeal cancer: A little known anatomo-clinical entity. Gastroenterol. Clin. Biol.7:843, 1983
Kramer, S., Gelber, R., Snow, J., Marcial, V., Lowry, L., Davis, L.: Preoperative vs. postoperative radiation therapy in advanced squamous cell carcinoma of the head and neck: Final report on study 73-03 of the Radiation Therapy Oncology Group. Abstr. Am. J. Clin. Oncol. (CCT)6:150, 1983
Schenken, L.L., Burholt, D.R., Kovacs, C.J.: Adriamycin, radiation combination: Drug induced delayed gastro-intestinal radiosensitivity. Int. J. Radiat. Oncol. Biol. Phys.5:1265, 1979
Chabora, B.M., Hopfan, S., Wittes, R.: Esophageal complications in the treatment of oat cell carcinoma with combined irradiation and chemotherapy. Radiology123:185, 1977
Greco, F.A., Brereton, H.D., Kent, C.H., Zimbler, H., Merrill, J., Johnson, R.E.: Adriamycin and enhanced radiation reaction in normal esophagus and skin. Ann. Intern. Med.85:294, 1976
Soreide, O., Janssen, C.W., Kvam, G., Hartveit, F.: Aorto-oesophageal fistula complicating carcinoma of the oesophagus. Scand. J. Thorac. Cardiovasc. Surg.10:79, 1976
Philips, T.L., Fu, K.K.: Quantification of combined radiation therapy and chemotherapy effects on critical normal tissues. Cancer37:1186, 1976
Giever, R.J., Heuskinveld, R.S., Manning, M.R., Bowden, G.T.: Enhanced radiation reaction following combination chemotherapy for small cell carcinoma of the lung, possibly secondary to VP16-213. Int. J. Radiat. Oncol. Biol. Phys.8:921, 1982
Johnson, R.E., Brereton, H.D., Kent, C.H.: Small cell carcinoma of the lung: Attempts to remedy causes of past therapeutic failure. Lancet2:289, 1976
Feld, R.: Complications in the treatment of small cell carcioma of the lung. Cancer Treat. Rev.8:5, 1981
Moore, T.N., Livingston, R., Heilbrun, L., Durrance, F.Y., Tesh, D., Hickman, B., Bogardus, C.: An acceptable rate of complications in combined doxorubicin-irradiation for small cell carcinoma of the lung: A Southwest Oncology Group Study. Int. J. Radiat. Oncol. Biol. Phys.4:675, 1978
Kinsella, T.J., Bloomer, W.D.: Tolerance of the intestine to radiation therapy. Surg. Gynecol. Obstet.151:273, 1980
Stryker, J.A., Demers, L.M.: The effect of pelvic irradiation on the absorption of bile acids. Int. J. Radiat. Oncol. Biol. Phys.5:935, 1979
Mennie, A.T., Dalley, V.M., Dinneen, L.C., Collier, H.O.J.: Treatment of radiation-induced gastrointestinal distress with acetylsalicylate. Lancet2:942, 1975
Strockbine, M.F., Hancock, J.E., Fletcher, G.H.: Complications in 831 patients with squamous cell carcinoma of the intact uterine cervix treated with 3,000 rads or more whole pelvis irradiation. Presented at the Fifty-first Annual Meeting of the American Radium Society, Philadelphia, April 27–30, 1969
Deitel, M., Vasic, V.: Major intestinal complications of radiotherapy. Am. J. Gastroenterol.72:65, 1979
Cram, A.E., Pearlman, N.W., Jochimsen, P.R.: Surgical management of complications of radiationinjured gut. Am. J. Surg.133:551, 1977
DeCosse, J.J., Rhodes, R.S., Wentz, W.B., Reagan, J.W., Dworken, H.J., Holden, W.D.: The natural history and management of radiation induced injury of the gastrointestinal tract. Presented at the Annual Meeting of the American Surgical Association, Cincinnati, Ohio, April 30–May 3, 1969
Localio, S.A., Stone, A., Friedman, M.: Surgical aspects of radiation enteritis. Surg. Gynecol. Obstet.129:1163, 1969
Bricker, E.M., Johnston, W.D., Kraybill, W.G., Lopez, M.J.: Reconstructive surgery for the complications of pelvic irradiation. Am. J. Clin. Oncol. (CCT)7:81, 1984
Morgenstern, L., Thompson, R., Friedman, N.B.: The modern enigma of radiation enteropathy: Sequelae and solutions. Am. J. Surg.134:166, 1977
Hamberger, A.D., Unal, A., Gershenson, D.M., Fletcher, G.H.: Analysis of the severe complications of irradiation of carcinoma of the cervix; whole pelvis irradiation and intracavitary radium. Int. J. Radiat. Oncol. Biol. Phys.9:367, 1983
Kotmeier, H.L., Gray, M.J.: Rectal and bladder injuries in relation to radiation dosage in carcinoma of the cervix. A 5-year followup. Am. J. Obstet. Gynecol.82:74, 1961
Perez, C.A., Breaux, S., Madoc-Jones, H., Camel, H.M., Purdy, J., Sharma, S., Powers, W.E.: Correlation between radiation dose and tumor recurrence and complications in carcinoma of the uterine cervix: Stages I and IIA. Int. J. Radiat. Oncol. Biol. Phys.5:373, 1979
Unal, A., Haerger, A.D., Seski, J.C., Fletcher, G.H.: An analysis of the severe complications of irradiation of carcinoma of the uterine cervix: Treatment with intracavitary radium and parametrial irradiation. Int. J. Radiat. Oncol. Biol. Phys.7:999, 1981
Leibel, S.A., Hanks, G.E., Kramer, S.: Patterns of care outcome studies: Results of the national practice in adenocarcinoma of the prostate. Int. J. Radiat. Oncol. Biol. Phys.10:401, 1984
Pilepich, M.V., Perez, C.A., Walz, B.J., Zivnuska, F.R.: Complications of definitive radiotherapy for carcinoma of the prostate. Int. J. Radiat. Oncol. Biol. Phys.7:1341, 1981
Rangala, N., Cox, J.D., Byhardt, R.W., Wilson, J.F., Greenberg, M., Lopes da Conceicao, A.: Local control and survival after external irradiation for adenocarcinoma of the prostate. Int. J. Radiat. Oncol. Biol. Phys.8:1909, 1982
Dewit, L., Kian Ang, K., Van der Schueren, E.: Acute side effects and late complications after radiotherapy of localized carcinoma of the prostate. Cancer Treat. Rev.10:79, 1983
Potish, R.A.: Important of predisposing factors in the development of enteric damage. Am. J. Clin. Oncol. (CCT)5:189, 1982
Green, N., Iba, L.G., Smith, W.R.: Measures to minimize small intestine injury in the irradiated pelvis. Cancer35:1633, 1975
van Nagell, J.R., Jr., Maruyama, Y., Parker, J.C., Dalton, W.L.: Small bowel injury following radiation therapy for cervical cancer. Am. J. Obstet. Gynecol.118:163, 1974
Potish, R.A., Jones, T.K., Jr., Levitt, S.H.: Factors predisposing to radiation-related small bowel damage. Radiology132:479, 1979
Danjoux, C.E., Catton, G.E.: Delayed complications in colo-rectal carcinoma treated by combination radiotherapy and 5-fluorouracil—Eastern Cooperative Oncology Group (ECOG) pilot study. Int. J. Radiat. Oncol. Biol. Phys.5:311, 1979
Habeshaw, T., Adam, J.L.S., Kirk, J.: Weekly large fraction radiotherapy and 5-fluorouracil as palliative treatment for large bowel carcinoma: A pilot study. Int. J. Radiat. Oncol. Biol. Phys.8:1127, 1982
Twiggs, L.B., Potish, R.A.: Decision theory analysis of the enteric morbidity and surgical staging in the treatment of advanced cervical cancer. Am. J. Obstet. Gynecol.48:134, 1984
Laugier, A., Schlienger, M., Le Fur, R., Eschwege, F.: La prévention des radiolésions digestives. Sem. Hop. Paris44:449, 1968
Chism, S.E., Keys, H.M., Gillin, M.T.: Carcinoma of the cervix: A time dose analysis of control and complications. Am. J. Roentgenol. Radium Ther. Nucl. Med.123:84, 1975
Pourquier, H., Dubois, J.B., Delard, R.: Cancer of the uterine cervix: Dosimetric guidelines for prevention of late rectal and rectosigmoid complications as a result of radiotherapeutic treatment. Int. J. Radiat. Oncol. Biol. Phys.8:1887, 1982
Cohen, A.M., Gunderson, L.L., Welch, C.E.: Selective use of adjuvant radiation therapy in resectable colorectal adenocarcinoma. Dis. Colon Rectum24:247, 1981
Million, R.R., Cassisi, N.J.: Management of Head and Neck Cancer: A Multidisciplinary Approach. Philadelphia, J.B. Lippincott, 1984, chap. 14, pp. 173–208
Parsons, J.T., Bova, F.J., Million, R.R.: A reevaluation of split-course technique for squamous cell carcinoma of the head and neck. Int. J. Radiat. Oncol. Biol. Phys.6:1645, 1980
Murray, C.G., Herson, J., Daly, T.E., Zimmerman, S.: Radiation necrosis of the mandible: A 10-year study. Part I. Factors influencing the onset of necrosis. Int. J. Radiat. Oncol. Biol. Phys.6:543, 1980
Spanos, W.J., Shukovsky, L.J., Fletcher, G.H.: Time, dose and tumor volume relationships in irradiation of squamous cell carcinomas of the base of the tongue. Cancer37:2591, 1976
Morrish, R.B., Jr., Chan, E., Silverman, S., Jr., Meyer, J., Fu, K.K., Greenspan, D.: Osteonecrosis in patients irradiated for head and neck carcinoma. Cancer47:1980, 1981
Bedwinek, J., Shukovsky, L.J., Fletcher, G.H., Daley, T.E.: Osteonecrosis in patients treated with definitive radiotherapy for squamous cell carcinoma of the oral cavity and naso- and oropharynx. Radiology199:665, 1976
Beumer, J., Silverman, S., Jr., Benak, S.: Hard and soft tissue necroses following radiation therapy for oral cancer. J. Prosthet. Dent.27:640, 1972
Murray, C.G., Herson, J., Daly, T.E., Zimmerman, S.: Radiation necrosis of the mandible: A 10-year study. Part II. Dental factors; onset duration and management of necrosis. Int. J. Radiat. Oncol. Biol. Phys.6:549, 1980
Daly, T.E.: Dental care in the irradiated patient. In Textbook of Radiotherapy, G.H. Fletcher, editor. Philadelphia, Lea and Febiger, 1980, chap. 3, pp. 229–337
Parsons, J.T., Cassisi, N.J., Million, R.R.: Results of twice-a-day irradiation of squamous cell carcinomas of the head and neck. Int. J. Radiat. Oncol. Biol. Phys.10:2041, 1984
Marcial, V.A., Hanley, J.A., Hendrickson, F., Ortiz, H.: Split-course radiation therapy of carcinoma of the base of the tongue: Results of a prospective national collaborative clinical trial conducted by the Radiation Therapy Oncology Group. Int. J. Radiat. Oncol. Biol. Phys.9:437, 1983
Samaan, N.A., Vieto, R., Schultz, P.N., Maor, M., Meoz, R.T., Sampiere, V.A., Cangir, A., Ried, H.L., Jesse, R.H., Jr.: Hypothalamic, pituitary and thyroid dysfunction after radiotherapy to the head and neck. Int. J. Radiat. Oncol. Biol. Phys.8:1857, 1982
Wara, W.M., Richards, G.E., Grumbach, M.M., Kaplan, S.L., Sheline, G.E., Conte, F.A.: Hypopituitarism after irradiation in children. Int. J. Radiat. Oncol. Biol. Phys.2:549, 1977
Harrop, J.S., Davies, T.J., Capra, L.G., Marks, V.: Hypothalamic-pituitary function following successful treatment of intracranial tumors. Clin. Endocrinol.5:313, 1976
Perry-Keene, D.A., Connelly, J.F., Young, R.A., Wettenhall, H.N.B., Martin, F.I.R.: Hypothalamic hypopituitarism following external radiotherapy for tumours distant from the adenohypophysis. Clin. Endocrinol.5:373, 1976
Shalet, S.M., Beardswell, C.G., Pearson, D., Morris-Jones, P.H.: The effect of varying doses of cerebral irradiation on growth hormone production in childhood. Clin. Endocrinol.5:287, 1976
Fuks, Z., Glatstein, E., Marsa, G.W., Bagshaw, M.A., Kaplan, H.S.: Long-term effects of external radiation on the pituitary and thyroid glands. Cancer37:1152, 1976
Fajardo, L.F., Berthrong, M.: In Pathology of Radiation Injury, New York, Masson Publishing USA Inc., 1982, pp. 186–200
Parker, R.G.: Selective use of radiation therapy for neoplasms of skin. Clin. Plast. Surg.7:337, 1980
Montague, E.D., Frederick, C.A., Schell, S.R., Romsdahl, M.M.: Conservation surgery and irradiation as an alterantive to mastectomy in the treatment of clinically favorable breast cancer. Cancer54:2668, 1984
Sause, W.: Late skin changes following twice weekly electron beam radiation to post-mastectomy chest walls. Int. J. Radiat. Oncol. Biol. Phys.7:1341, 1981
Danoff, B.F., Goodman, R.L., Glick, J.H., Haller, D.G., Pajak, T.F.: The effect of adjuvant chemotherapy on cosmesis and complications in patients with breast cancer treated by definitive irradiation. Int. J. Radiat. Oncol. Biol. Phys.9:1625, 1983
Ray, G.R., Fish, V.J.: Biopsy and definitive radiation therapy in stage I and II adenocarcinoma of the female breast: Analysis of cosmesis and the role of electron beam supplementation. Int. J. Radiat. Oncol. Biol. Phys.9:813, 1983
Mansfield, C.M.: Effects of radiation therapy on wound healing after mastectomy. Clin. Plast. Surg.6:19, 1979
Rubin, P., Casarett, G.W.: Clinical Radiation Pathology, vol. 2. Philadelphia, W.B. Saunders Co., 1968
Gonzales, D.G., Breur, K.: Clinical data from irradiated growing long bones in children. Int. J. Radiat. Oncol. Biol. Phys.9:841, 1983
Probert, J.C., Parker, B.R.: The effects of radiation therapy on bone growth. Radiology114:155, 1975
Arkin, A.M., Pack, G.T., Ransohoff, N.S.: Radiation induced scoliosis. A case report. J. Bone Joint Surg.32:401, 1950
Rubiń, P., Duthie, R.B., Young, L.W.: The signifcance of scoliosis. A case report. J. Bone Joint Surg.32:401, 1950
Vaeth, J.M., Levitt, S.H., Jones, M.D., Holtfreter, C.: Effects of radiation therapy in survivors of Wilms' tumor. Radiology79:560, 1962
Parker, R.G., Berry, H.C.: Late effects of therapeutic irradiation on the skeleton and bone marrow. Cancer37:1162, 1976
Ray, G.R., Cassady, J.R., Bagshaw, M.A.: Definitive radiation therapy of carcinoma of the prostate. Radiology106:407, 1973
Dalby, R.G., Jacox, H.W.: Fracture of the femoral neck following irradiation. Am. J. Obstet. Gynecol.32:50, 1936
Rigler, L.G., Gratzek, F.R., Holmstrom, F.G.: Postirradiation bone changes. Am. J. Roentgenol.53:62, 1945
Ackerman, L.V.: An evaluation of the treatment of cancer of the breast at the University of Edinburgh under the direction of Dr. R. McWhirter. Cancer8:883, 1955
Harris, J.R., Levene, M.B., Svensson, G., Hellman, S.: Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int. J. Radiat. Oncol. Biol. Phys.5:257, 1979
Prosnitz, L.R., Lawson, J.R.: Avascular necrosis of bone in Hodgkin's disease patients treated with combined modality therapy. Cancer47:2793, 1981
Jentzsch, K., Binder, H.: Leg function after radiotherapy for Ewing's sarcoma. Cancer47:1267, 1981
Parker, R.G., Wildermuth, O.: Radiation therapy of lesions overlying cartilage. Carcinoma of the pinna. Cancer15:57, 1962
Borgelt, B., Gelber, R., Larson, M., Hendrickson, F., Griffin, T., Roth, R.: Ultra-rapid high dose irradiation schedules for the palliation of brain metastases: Final results of the first two studies by the Radiation Therapy Oncology Group. Int. J. Radiat. Oncol. Biol. Phys.7:1633, 1981
Salazar, O.M., Rubin, P., McDonald, J.V., Feldstein, M.L.: High dose radiation therapy in the treatment of glioblastoma multiforme: A preliminary report. Int. J. Radiat. Oncol. Biol. Phys.1:717, 1976
Freeman, J.E., Johnston, P.G.B., Voke, J.M.: Somnolence after prophylactic cranial irradiation in children with acute lymphoblastic leukaemia. Br. Med. J.4:523, 1973
Sheline, G.E., Wara, W.N., Smith, V.: Therapeutic irradiation and brain injury. Int. J. Radiat. Oncol. Biol. Phys.6:1215, 1980
Peylan-Ramu, N., Poplack, D.G., Pizzo, P.A., Adornato, B.T., Di Chiro, G.: Abnormal CT scans of the brain in asymptomatic children with acute lymphocytic leukemia after prophylactic treatment of the central nervous system with radiation and intrathecal chemotherapy. N. Engl. J. Med.298:815, 1978
Price, R.A.: Histopathology of CNS leukemia and complications of therapy. Am. J. Pediatr. Hematol. Oncol.1:21, 1979
Bleyer, W.A., Griffin, T.W.: White matter necrosis, mineralizing microangiopathy and intellectual abilities in survivors of childhood leukemia: Associations with central nervous system irradiation and methotrexate therapy. In Radiation Damage to the Nervous System: A Delayed Therapeutic Hazard, H.A. Gilbert and A.R. Kagan, editors. New York, Raven Press, 1980, pp. 155–174
Price, R.A., Birdwell, D.A.: The central nervous system in childhood leukemia. III. Mineralizing microangiopathy and dystrophic calcification. Cancer42:717, 1978
Lee, K.F., Suh, J.H.: CT evidence of gray matter calcification secondary to radiation therapy. Comput. Tomogr.1:103, 1977
Edwards, M.S., Wilson, C.B.: Treatment of radiation necrosis. In Radiation Damage to the Nervous System: A Delayed Therapeutic Hazard, H.A. Gilbert and A.R. Kagan, editors. New York, Raven Press, 1980, pp. 129–144
Jones, A.: Transient radiation myelopathy (with reference to Lhermitte's sign of electrical paresthesia). Br. J. Radiol.37:727, 1964
Hutchinson, G.: Survival and complications of radiation therapy following involved and extended field therapy of Hodgkin's disease, stages I and II. Cancer38:288, 1976
Carmel, R.J., Kaplan, H.S.: Mantle irradiation in Hodgkin's disease. Cancer37:813, 1976
Dynes, J.B., Smedal, M.I.: Radiation myelitis. Am. J. Roentgenol.83:78, 1960
Phillips, T.L., Buschke, F.: Radiation tolerance of the thoracic spinal cord. Am. J. Roentgenol.105:659, 1969
Wollin, M., Kagan, A.R.: Modification of biological dose to normal tissue by daily fractionation. Acta Radiol.15:481, 1976
Cheng, V.S.T., Schultz, M.D.: Unilateral hypoglossal nerve atrophy as a late complication of radiation therapy of head and neck carcinoma. Cancer35:537, 1975
Berger, P.S., Bataini, J.P.: Radiation-induced cranial nerve palsy. Cancer40:152, 1977
Stoll, B.A., Andrews, J.T.: Radiation-induced peripheral neuropathy. Br. Med. J.1:834, 1966
Thomas, J.E., Colby, M.Y.: Radiation-induced or metastatic brachial plexopathy? A diagnostic dilemma. J.A.M.A.222:392, 1972
del Regato, J.A.: Historical changes in time-dose relationships in therapeutic radiology. Front. Radiat. Ther. Oncol.3:1, 1968
Strandqvist, M.: Studien über die Kumulative Wirkung der Rontgenstrahlen bei Fraktionierung. Acta Radiol. (Stockh.) [Suppl.]55:1, 1944
Ellis, F.: The relationship of biological effect to dose-time-fractionation factors in radiotherapy. In Current Topics in Radiation Research, M. Ebert and A. Howard, editors. Amsterdam, North Holland Publishing, 1968, pp. 357–397
Kirk, J., Gray, W.M., Watson, E.F.: Cumulative radiation effect. Part I. Fractionated treatment regimes. Clin. Radiol.22:145, 1971
Orton, C.G., Ellis, F.: A simplification in the use of the NSD concept in practical radiotherapy. Br. J. Radiol.46:529, 1973
Thames, H.D., Jr., Withers, H.R., Peters, L.J., Fletcher, G.H.: Changes in early and late radiation responses with altered dose fractionation: Implications for dose-survival relationships. Int. J. Radiat. Oncol. Biol. Phys.8:219, 1982
Cox, J.D.: Large-dose fractionation (hypofractionation). Cancer55:2105, 1985
Withers, H.R.: Biologic basis for altered fractionation schemes. Cancer55:2086, 1985
Dobelbower, R. et al.: Pancreatic carcinoma treated with high-dose, small-volume irradiation. Cancer41:1088, 1978
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Cox, J.D., Byhardt, R.W., Wilson, J.F. et al. Complications of radiation therapy and factors in their prevention. World J. Surg. 10, 171–188 (1986). https://doi.org/10.1007/BF01658134
Issue Date:
DOI: https://doi.org/10.1007/BF01658134