Department of Oncology, Jinan Central Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Shandong First Medical University, No. 105, Jie Fang Road, Jinan, 250013, Shandong, China.
Department of Radiation Oncology, Shandong Academy of Medical Sciences, Shandong Cancer Hospital Affiliated to Shandong University, No. 440 Jiyan Road, Jinan, 250117, Shandong, China.
Int J Clin Oncol. 2020 Jun;25(6):1010-1015. doi: 10.1007/s10147-020-01662-5. Epub 2020 Apr 18.
Perforation of gastrointestinal (GI) tract is a rare, but serious complication of abdominopelvic irradiation, and it can even occur several years after radiotherapy. As one of the symptoms of radiation enteropathy, it shares common features with other chronic complications and has its own characteristic at the same time. It has been reported that some systematic therapies, such as sorafenib and bevacizumab, could add the risk of radiation-induced GI perforation. The potential mechanisms of aggravated GI injury may be exacerbation of epithelial cell damage, microvascular damage or subsequent inflammatory response. The complicated situation makes it almost impossible to set uniform dose constraints for GI perforation prevention. The majority of cancer patients with GI perforation require emergency surgery, and there is no high quality evidence for supporting the use of any prevention measures. In this review, we summarize the clinical manifestation, risk factors, mechanism, and therapy of radiation-induced GI perforation. A comprehensive treatment plan is crucial to improve the quality of life for cancer survivors.
胃肠道（GI）穿孔是腹盆部放疗少见但严重的并发症，甚至在放疗后数年仍可发生。作为放射性肠炎的症状之一，它与其他慢性并发症有共同特征，同时也有其自身特点。有报道称，索拉非尼和贝伐珠单抗等一些系统治疗方法可能会增加放射性 GI 穿孔的风险。加重 GI 损伤的潜在机制可能是上皮细胞损伤、微血管损伤或随后的炎症反应加重。这种复杂的情况使得几乎不可能为预防 GI 穿孔制定统一的剂量限制。大多数发生 GI 穿孔的癌症患者需要紧急手术，也没有高质量的证据支持使用任何预防措施。在这篇综述中，我们总结了放射性 GI 穿孔的临床表现、危险因素、机制和治疗。综合治疗方案对于提高癌症幸存者的生活质量至关重要。
