The normal tissue tolerance and the related early side effects represent the main constraint on the total radiation dose which can be administered to the target volume. The most common disorders during radiotherapy or chemo-radiotherapy are summarized in this review. Since in the recent years great advances have been made towards the improvement of acute tolerance, practically every adverse symptoms can be controlled or lowered with an adequate treatment. Some suggestions are reported in order to prevent or lower the degree and the incidence of major complications, specifically mucositis-related symptoms like stomatitis, diarrhea, cystitis. Possibly, a multicenter effort is to be made in order to optimize the quality of supportive care for irradiated patients in all radiation therapy centers.
ArnaudJ.P., NordlingerB., BossetJ.F., Hoctin BoesG., SammoudT., SchlagP.M., PeneF.: Radical surgery and postoperative radiotherapy as combined treatment in rectal cancer. Final results of a phase III study of the European Organization for Research and Treatment of Cancer.Br. J. Surg.,84: 352–357, 1997.
2.
Ausili-CèfaroG., MarmiroliL., NardoneL., SalviG., Abu RumeilehI.: Long-term continuous infusion of Carboplatin and concomitant radiotherapy in Head and Neck cancer.Proc. ASCO.,12: A280, 1993.
3.
Ausili-CèfaroG., MarmiroliL., SalviG., ZiccarelliL., MarucciL., NardoneL.: Prevention of mucositis and leukopenia produced by radiochemotherapy with the use of rh-GM-CSF and rh-G-CSF in patients with advanced head and neck cancer. Proceedings Fourth International Conference on Head and Neck Cancer, Toronto. Abs. 56, 1996.
4.
BabbR.R.: Radiation Proctitis: a review.Am. J. Gastroenterol.,91: 1309–1311, 1996.
5.
Baille-JohnsonH.R.: Octreotide in the management of treatment-related diarrhoea.Anticancer Drugs,7(suppl. 1): 11–15, 1996.
BuchiK.: Radiation proctitis: Therapy and prognosis.JAMA,265: 1180, 1991.
8.
CinatG., MickiewiczE., AlvarezA., BrosioC., GiglioR., EzcurdiaL.: Local use of GM-CSF in the treatment of severe mucositis. A preliminary trial.Proc. ASCO,16: A216, 1997.
9.
DewanA.K., MohanG.M., RaviR.: Intravesical formalin for hemorrhagic cystitis following irradiation of cancer of the cervix.Int. J. Gynaecol. Obstet.,42: 131–135, 1993.
10.
FranzènL., HenrikssonR., LittbrandB., BiornZ.: Effects of sucralfate on mucositis during and following radiotherapy of malignancies in the head and neck.Acta Oncol.,34: 219–223, 1995.
11.
HombrinkJ., VossA.C., FrohlichD., GlatzelM., KraubA., GlaserF.H.: Therapy trends in the prevention of radiation-induced diarrhea after pelvic and abdominal irradiation. Results of a tricenter study.Strahlenther. Onkol.,171: 49–53, 1995.
12.
JansmaJ., VissinkA., SpijkervetF., RoodenburgJ., PandersA., VermeyA., SzaboB., Johannes's-GravenmadeE.: Protocol for the prevention and treatment of oral sequelae resulting from head and neck radiation therapy.Cancer,70: 2171–2180, 1992.
13.
JohnsonJ.T., FerrettiG.A., NetheryW.J., ValdezI.H., FoxP.C., NgD., MuscoplatC.C., GallagherS.G.: Oral pilocarpine for post-irradiation xerostomia in patients with head and neck cancer.N. Engl. J. Med.,329: 390–395, 1993.
LeVequeF.G., MontgomeryM., PotterD., ZimmerM.B., RiekeJ.W., SteigerB.W., GallagherS.C., MuscoplatC.C.: A multicenter, randomized, double-blind, placebo-controlled, dose-titration study of oral pilocarpine for treatment of radiation-induced xerostomia in head and neck cancer patients.J. Clin. Oncol,11: 1124–1131, 1993.
16.
MakkonenT.A., BostromP., ViljaP., JoensuuH.: Sucralfate mouth washing in the prevention of radiation-induced mucositis: a placebo-controlled double-blind randomized study.Int. J. Radiat. Oncol. Biol. Phys.,30: 177–182, 1994.
17.
MeredithR., SalterM., KimR.: Sucralfate for radiation mucositis: results of a double-blind randomized trial.Int. J. Radiat. Oncol. Biol. Phys.,37: 275–279, 1997.
18.
O'BrienP.C., FranklinC.I., DearK.B., HamiltonC.C., PoulsenM., JosephD.J., SpryN., DenhamJ.W.: A phase III double-blind randomised study of rectal sucralfate suspension in the prevention of acute radiation proctitis.Radiother. Oncol.,45: 117–123, 1997.
19.
PfeifferP., HanseO., MadsenE.L., MayO.: A prospective pilot study on the effect of sucralfate mouth-swishing in reducing stomatitis during radiotherapy of the oral cavity.Acta Oncol.,29: 471–473, 1990.
20.
ResbeutM., MarteauP., CowenD., RichaudP., BourdinS., Bernard DuboisJ., MereP., N'GuyenT.D.: A randomized double blind placebo controlled multicenter study of mesalazine for the prevention of acute radiation enteritis.Radiother. Oncol.,44: 59–63, 1997.
21.
SpijkertvetF.K.L., van SaeneH.K.F., van SaeneJ.J.M., PandersA.K., VermeyA., MehtaD.M.: Mucositis prevention by selective elimination of oral flora in irradiated head and neck cancer patients.J. Oral Pathol. Med.,19: 486–489, 1990.
22.
WangC.Jr., LeungS.W., ChenH.C.: The correlation of acute toxicity and late rectal injury in radiotherapy for cervical carcinoma: evidence suggestive of consequential late effect (CQLE).Int. J. Radiat. Oncol. Biol. Phys.,40: 85–91, 1998.
23.
WardH.E., KemsleyL., DaviesL., HolecekM., BerendN.: The effect of steroids on radiation-induced lung disease in the rat.Radiat. Res.,136: 22–28, 1993.
24.
WidmarkA., FranssonP., FranzenL.: Daily-diary evaluated side-effects of conformai versus conventional prostatic cancer radiotherapy technique.Acta Oncol.,36: 499–507, 1997.
