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Chapter 37 - Treatment-Related Adverse Effects

Published online by Cambridge University Press:  24 April 2026

By
Huda Fatima
Edited by
Angela Bray Lindsay and
Monica Kathleen Wattana
Angela Bray Lindsay
Affiliation:
Virginia Commonwealth University
Monica Kathleen Wattana
Affiliation:
University of Texas, MD Anderson Cancer Center
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Summary

1. Radiation therapy is a crucial treatment method for various cancers, used alone or with chemotherapy and surgery.

2. Radiation-Induced Oral Mucositis (RIOM) is the most common and significant side effect, which worsens with higher doses delivered over a shorter period of time.

3. Radiation Proctitis is a common side effect, characterized by inflammation of the rectal mucosa due to radiation. Acute proctitis usually appears within three months of starting therapy and can last up to six months, potentially progressing to chronic proctitis after therapy.

4. Acute Radiation-Induced Esophagitis (ARIE) symptoms usually arise within the first two months of radiotherapy and adversely affect the quality of life, often causing unplanned pauses in treatment and lessening therapy effectiveness.

5. Radiation-induced pneumonitis is a significant concern in patients receiving radiation for lung, breast, and lymphoma cancers, and in those undergoing total body irradiation for bone marrow transplants with systemic glucocorticoids being the preferred treatment that can lead to symptom relief and radiographic improvement although relapse is possible post-treatment.

Keywords

radiation therapyradiotherapyneuropathybrachytherapyradiation induced oral mucositisamifostinephlebitisnecrosisesophagitisradiation dermatitisrectal bleedingdysuriacystitispneumonitisdyspnea acute radiation induced esophagitislos angeles classification

Information

Type
Chapter
Information
Oncologic Emergency Medicine
Clinical Cases Illustrating Key Concepts
 , pp. 185 - 203
Publisher: Cambridge University Press
Print publication year: 2026

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References

Further Reading

Alesawi, AM, El-Hakim, A, Zorn, KC, Saad, F. Radiation-induced hemorrhagic cystitis. Curr Opin Support Palliat Care. 2014;8(3):235–240. doi:10.1097/SPC.0000000000000073CrossRefGoogle ScholarPubMed
Arroyo-Hernández, M, Maldonado, F, Lozano-Ruiz, F, Muñoz-Montaño, W, Nuñez-Baez, M, Arrieta, O. Radiation-induced lung injury: current evidence. BMC Pulm Med. 2021;21(1):9. doi:10.1186/s12890-020-01376-4CrossRefGoogle ScholarPubMed
Bergamaschi, L, Vincini, MG, Zaffaroni, M, Pepa, M, Angelicone, I, Astone, A, et al. Management of radiation-induced oral mucositis in head and neck cancer patients: a real-life survey among 25 Italian radiation oncology centers. Support Care Cancer. 2023;32(1):38. doi:10.1007/s00520-023-08185-5Google ScholarPubMed
Hanania, AN, Mainwaring, W, Ghebre, YT, Hanania, NA, Ludwig, M. Radiation-induced lung injury: assessment and management. Chest. 2019;156(1):150–162. doi:10.1016/j.chest.2019.03.033CrossRefGoogle ScholarPubMed
Howell, DD. The role of radiation therapy in the palliation of gastrointestinal malignancies. Gastroenterol Clin N Am. 2006;35:125–130.CrossRefGoogle ScholarPubMed
Johnson, JT. Prevention of radiation-induced mucositis. Curr Oncol Rep. 2001;3(1):56–58 doi:10.1007/s11912-001-0043-2CrossRefGoogle ScholarPubMed
Murofushi, KN, Tomita, T, Ohnishi, K, Nakai, K, Akiyama, A, Saida, T, et al. Risk factors for venous thromboembolism induced by prolonged bed rest during interstitial brachytherapy for gynecological cancer: a retrospective study. Radiat Oncol. 2021;16(1):121. doi:10.1186/s13014-021-01840-3CrossRefGoogle ScholarPubMed
Porouhan, P, Farshchian, N, Dayani, M. Management of radiation-induced proctitis. J Family Med Prim Care. 2019;8(7):2173–2178. doi:10.4103/jfmpc.jfmpc_333_19CrossRefGoogle ScholarPubMed
Rosenthal, A, Israilevich, R, Moy, R. Management of acute radiation dermatitis: a review of the literature and proposal for treatment algorithm. J Am Acad Dermatol. 2019;81(2):558–567. doi:10.1016/j.jaad.2019.02.047CrossRefGoogle ScholarPubMed
Tabaja, L, Sidani, SM. Management of radiation proctitis. Dig Dis Sci. 2018;63(9):2180–2188. doi:10.1007/s10620-018-5163-8CrossRefGoogle ScholarPubMed
Wang, Y, Zhu, Y, Xu, X. Advances in the management of radiation-induced cystitis in patients with pelvic malignancies. Int J Radiat Biol. 2023;99(9):1307–1319. doi:10.1080/09553002.2023.2181996CrossRefGoogle ScholarPubMed
Werner-Wasik, M, Paulus, R, WJ, Curran Jr, Byhardt, R. Acute esophagitis and late lung toxicity in concurrent chemoradiotherapy trials in patients with locally advanced non-small-cell lung cancer: analysis of the radiation therapy oncology group (RTOG) database. Clin Lung Cancer. 2011;12:245–251.CrossRefGoogle ScholarPubMed
Yang, X, Ren, H, Guo, X, Hu, C, Fu, J. Radiation-induced skin injury: pathogenesis, treatment, and management. Aging (Albany NY). 2020;12(22):23379–23393. doi:10.18632/aging.103932Google ScholarPubMed

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