TABLE 1072 Chemotherapeutic Agents and Their Toxicities

The complications related to radiation are temporally divided into acute and chronic. The chronic manifestations may be further broken into gastrointestinal, genitourinary, and pulmonary. Acute findings include nausea, vomiting, diarrhea, cystitis, nephritis, pneumonitis, and myelosuppression. Gastrointestinal symptoms are often self-limiting and are controlled with supportive therapy including antiemetics, antidiarrheals, and avoidance of high-fiber diets. Newer studies point to glutamine-rich diets, and the use of sucralfate may further reduce diarrhea. The genitourinary symptoms range from infection to hemorrhagic cystitis with extreme pain. Treatment of these symptoms includes adequate hydration, surveillance for infection, and bladder irrigation with analgesia or steroids. Resolution of myelosuppression is often spontaneous and begins after radiation has been completed.

Chronic findings are divided into gastrointestinal, genitourinary, and pulmonary. The most common complication is radiation enteritis, which presents with chronic diarrhea, malabsorption, or digestive difficulty. Other chronic gastrointestinal complications include strictures, fistulas, perforations, obstructions, and hematochezia. These findings often occur within 2 years of treatment. Management should be a collaborative effort between the oncologist, surgeon, and gastroenterologist. Emergency management includes adequate hydration and symptomatic relief. Genitourinary complications include incontinence, fistula formation, stricture formation, and hemorrhagic cystitis. Incontinence and fistulas were discussed earlier. The most severe complication of stricture formation is obstructive uropathy. This always should be considered as recurrence of disease until proven otherwise and as a result of radiation by diagnosis of exclusion. Both hemorrhagic cystitis and stricture require cystoscopy for evaluation. An oncologist and urologist should institute appropriate treatment.

Lastly, secondary malignancies may arise from radiation therapy. This results from the local nonmalignant tissue being exposed to ionizing radiation. The resulting damage to genetic material leads to mutation that is the presumed mechanism for carcinogenesis. The secondary malignancy is often observed years after the initial radiation therapy, and accuracy in predicting its occurrence is difficult at best.

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