Chen Guangxia, Han Yi, Zhang Haihan, Tu Wenling, Zhang Shuyu
Department of Gastroenterology, The First People's Hospital of Xuzhou, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou, China.
The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China.
Front Oncol. 2021 Nov 5;11:757973. doi: 10.3389/fonc.2021.757973. eCollection 2021.
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.
放射治疗是治疗癌症的主要方法之一。消化系统由胃肠道和消化附属器官（舌、唾液腺、胰腺、肝脏和胆囊）组成。消化系统在放射治疗期间很容易受到损害，尤其是在胸部和腹部放射治疗中。在本综述中，我们介绍了放射治疗引起的消化损伤的物理分类、基本发病机制、临床特征、预测/诊断因素以及可能的治疗靶点。放射治疗引起的消化损伤符合剂量-体积效应，且与基于辐射的器官相关。计算机断层扫描（CT）、磁共振成像（MRI）、超声（US）和内镜检查有助于诊断和评估辐射引起的病变程度。最新的治疗方法包括改进放射治疗（如屏蔽、水凝胶间隔物和剂量分布）、干细胞移植和药物给药。调节肠道微生物群可能成为缓解放射性胃肠综合征的一种新方法。最后，我们总结了治疗中可能涉及的机制，但它们仍然各不相同。放射性核素标记的靶向分子（RLTMs）有望实现更精确的放射治疗。这些进展有助于我们对放射治疗引起的消化损伤的评估和治疗的理解。
