IRRADIATION INJURY TO THE GASTROINTESTINAL TRACT: CLINICAL FEATURES MANAGEMENT AND PATHOGENESIS
The signs, symptoms, and pathology of irradiation injury to the stomach and bowel are illustrated by the description of three patients treated for carcinoma of the uterine cervix, seminoma of the testis, and malignant teratoma of the testis, respectively. In all three cases the primary tumor had been removed, and direct irradiation was given for proven or suspected recurrence. Irradiation caused both direct irradiation injury to the intestinal epithelium and injury to blood vessels with depletion of blood supply; the latter process probably produced the greater damage. A variety of lesions occurred in the bowel, including ulceration, hemorrhage, perforation, fibrosis, obstruction, and malabsorption. Limited bowel resection became necessary in all 3 cases. Two patients survived, with impaired health but without clinical evidence of recurrence. Improved methods of irradiation are discussed. The dose of irradiation cannot be stated merely by the number of rad or r given, but must be expressed as a complex of the total dose given in a certain time, in certain fractions, and with fields of a specified size. The advantage of large fractions lies in the shorter duration of total treatment time, with probably more effective tumor destruction. The disadvantage of large fractions is that in the main the size of the field used must be restricted and the destructive effect on normal tissues is greater. The use of lower fractions, so as to give the dose in a longer time, reduces the possibility of serious damage to normal tissues, especially in tumors with a low therapeutic ratio, for which a higher total dose is necessary. Damage to normal tissue should be minimal if factors impairing tolerance are fully considered when treatment is being planned. On occasion, it is permissible to take a calculated risk of causing limited damage to normal tissues when no other form of treatment is possible, and when radiotherapy offers either reasonable hope of cure or considerable relief to distressing symptoms. In deciding upon this course, there should be a high degree of probability that there will be a net gain in health status by the patient. It is suggested that, to ensure the maximum irradiation to the cancer with minimum irradiation to the surrounding healthy tissues, more active shielding should be undertaken, even to the extent of laparotomy and displacement of the bowel during the period of irradiation. (BBB)
- Research Organization:
- Royal Melbourne Hospital, Melbourne
- NSA Number:
- NSA-18-011669
- OSTI ID:
- 4094774
- Journal Information:
- Australasian Ann. Med., Journal Name: Australasian Ann. Med. Vol. Vol: 12
- Country of Publication:
- Country unknown/Code not available
- Language:
- English
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