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Pathologic changes secondary to radiation

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Abstract

In order to be effective in the treatment of disease, especially neoplastic disease, radiation necessarily needs to be given in large doses. When treating tumors with high radiosensitivity in tissue of relatively low radiosensitivity, few complications of therapy occur. Frequently, however, the differential of sensitivity to radiation between the neoplasm and normal tissues exposed is small and the incidence of radiation injury to normal tissues becomes significant. Nowhere is this more apparent than in treatment of neoplasms during which the alimentary canal is heavily radiated. The following discussion will describe the pathologic changes that occur in the various units of the exposed alimentary tract and in various components of those units during and especially months or years after radiation therapy. The usual rapid and effective regeneration of the rapid-renewal cell system after injury will be noted. The serious delayed manifestations of injury to the fibrovascular tissues with resulting delayed complications of ulcerations, stenoses, fistula formation, and obstructing adhesions will be emphasized. Brief discussions of several other organ systems injured by radiation will be presented.

The development of second neoplasms as a result of radiation will be briefly mentioned and discussed from three standpoints: very low levels, low levels, and high levels of radiation.

Résumé

Pour traiter efficacement la maladie, en particulier les affections néoplasiques, l'irradiation nécessite l'emploi de doses importantes de rayons. Lorsque le traitement s'addresse à des tumeurs très radiosensibles siégeant au niveau de tissu peu radiosensible, les complications sont rares. Très souvent cependant la différence de sensibilité entre le tissu tumoral et le tissu normal est peu importante; c'est alors que les lésions secondaires à l'irradiation sont à redoute. Elles sont particulièrement fréquentes lorsque l'irradiation de la tumeur est susceptible de s'étendre au tractus digestif. Cet article décrit les modifications pathologiques qui peuvent se manifester au niveau des différentes parties du tube digestif et de leurs éléments constitutifs des mois ou des années après l'irradiation. La régénération habituelle rapide et efficace du système cellulaire est soulignée. Les manifestations pathologiques tardives et sérieuses au niveau du tissu fibro-vasculaire qui sont à l'origine des complications: ulcérations, sténoses, fistules, adhérences occlusives sont décrites. De courtes discussions sont consacrées aux autres organes susceptibles d'Être lésés par l'irradiation. Enfin la question de tumeurs qui peuvent Être provoquées par l'irradiation est également prise en considération, et ce, en fonction de son intensité que celle-ci soit très faible, faible ou forte.

Resumen

La efectividad en el tratamiento de la enfermedad neoplásica implica la necesidad de administrar irradiación en dosis elevadas. Pocas complicaciones se presentan cuando se emprende el tratamiento de tumores de gran radiosensibilidad ubicados en tejidos de baja radiosensibilidad. Sinembargo, con frecuencia el diferencial de sensibilidad a la irradiación entre el neoplasma y el tejido normal expuesto es pequeño y la incidencia de lesión por irradiación en los tejidos normales viene a ser significativa. Esto es especialmente aparente en el tratamiento de neoplasias que implique irradiación extensa del tracto gastrointestinal. La discusión en este trabajo describe los cambios patológicos que ocurren en las diferentes unidades del tracto gastrointestinal expuesto, así como en los variados componentes de tales unidades durante, y especialmente meses y años después, de la radioterapia. Es notoria la capacidad de rápida y efectiva regeneración del sistema de veloz recambio celular que se presenta después de la lesión. Se hace énfasis sobre las graves consecuencias tardías manifestadas por ulceración, estrecheces, fístulas y adherencias obstructivas. Se presenta una breve discusión sobre los otros sistemas orgánicos que pueden ser lesionados por la irradiación. El desarrollo de neoplasias secundarias como resultado de la irradiación se menciona brevemente, y se analiza desde tres puntos de vista: muy bajos niveles, bajos niveles y altos niveles de irradiación.

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Authors and Affiliations

  1. Department of Pathology, Penrose Hospital, P.O. Box 7021, 80933, Colorado Springs, Colorado, USA

    Morgan Berthrong M.D.

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Berthrong, M. Pathologic changes secondary to radiation. World J. Surg. 10, 155–170 (1986). https://doi.org/10.1007/BF01658133

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