• bleeding
• cancer
• chemotherapy
• diarrhoea
• radiotherapy

• prevention
• radiation injuries
• radiotherapy
• reconstructive surgery
• therapeutic strategies

• Chronic post-radiation proctitis
• Mesenchymal stromal cells
• Regenerative surgery
• Stromal-vascular fraction

• Humans
• Proctitis/therapy
• Proctitis/etiology
• Aged
• Adipose Tissue/cytology
• Radiation Injuries/therapy
• Radiation Injuries/pathology
• Male
• Transplantation, Autologous/methods
• Stromal Cells/transplantation

• Regenerative Therapy of Socially Significant Diseases FMBA of Russia

• Dysphagia
• Head and neck cancer
• Hyperbaric oxygen therapy
• Radiation therapy
• Swallowing disorders

• Humans
• Deglutition Disorders/etiology
• Deglutition Disorders/therapy
• Head and Neck Neoplasms/radiotherapy
• Hyperbaric Oxygenation/methods
• Radiation Injuries/therapy
• Radiation Injuries/etiology

• cancer radiotherapy
• pelvic malignancy
• radiation
• radiation proctitis
• severe proctitis

• Diarrhoea
• gastrointestinal symptoms
• pelvic radiotherapy
• rectal bleeding

• Humans
• Radiation Injuries/therapy
• Radiation Injuries/etiology
• Gastrointestinal Diseases/etiology
• Gastrointestinal Diseases/therapy
• Sucralfate/therapeutic use
• Quality of Life
• Randomized Controlled Trials as Topic
• Radiotherapy/adverse effects
• Pelvis/radiation effects
• Pelvic Neoplasms/radiotherapy
• Hyperbaric Oxygenation/methods

• Chronic painful radiation-induced neuropathy
• Chronic pelvic pain
• Chronic post cancer treatment pain
• Chronic post radiotherapy pain
• Pelvic radiation disease
• Postradiation
• Radiotherapy

• humans
• barotrauma
• barotrauma/therapy
• disease progression
• hyperbaric oxygenation
• hyperbaric oxygenation/methods
• neoplasms
• neoplasms/therapy
• osteoradionecrosis
• osteoradionecrosis/prevention & control
• pain
• radiation injuries
• radiation injuries/prevention & control

• Humans
• Hyperbaric Oxygenation/methods
• Radiation Injuries/prevention & control
• Neoplasms/therapy
• Osteoradionecrosis/prevention & control
• Disease Progression
• Pain
• Barotrauma/therapy

• hyperbaric oxygen
• hyperbaric oxygen therapy
• hyperbaric oxygenation
• late radiation tissue injury
• radiation injury
• radiation proctitis
• radiation-induced proctitis
• radiotherapy

• chronic radiation proctitis
• pelvic radiotherapy
• radiofrequency ablation

The aim of this study was to investigate the result of hyperbaric oxygen therapy (HBOT) in women with treated gynaecological malignancies who suffer from late radiation-induced tissue toxicity (LRITT). Moreover, which symptoms of LRITT benefit most from HBOT was evaluated as well.

An online literature search was conducted using PubMed; Embase and the Cochrane Library. Studies were included if the study examined gynaecological cancer patients who had been treated with radiotherapy, who suffered from LRITT and who subsequently received HBOT. In addition, the outcome measures were based on examining the effects of HBOT.

Twenty-one articles were included. The study investigating proctitis reported an improvement and three out of four studies investigating cystitis reported decreased complaints in women treated for gynaecological malignancies. In addition, all studies reported improvement in patients with wound complications and fifty percent of the studies reported better Patient Reported Outcome Measurements (PROMS) in women with gynaecological malignancies. Finally, all studies, except one related to pelvic malignancies reported reduced prevalence of symptoms for cystitis and proctitis and all studies reported better PROMS. However, only eleven studies reported p-values, nine of which were significant.

This study demonstrated that HBOT has a positive effect in women with gynaecological LRITT. Within the included patient group, gynaecological cancer patients with wound complications seem to benefit most from this treatment compared to other late side effects of LRITT.

The online version contains supplementary material available at 10.1186/s13014-022-02067-6.

• Gynaecological cancers
• Hyperbaric oxygen therapy
• Radiation oncology
• Systematic review
• Tissue toxicity

Acute radiation proctitis (ARP) is one of the most common complications of pelvic radiotherapy attributed to radiation exposure. The mechanisms of ARP are related to inflammation, angiogenesis, and so on. In this study we evaluated the effect of dexamethasone (DXM) combined with gentamicin (GM) enema on ARP mice, and explored its possible mechanisms by transcriptome sequencing, western blot and immunohistochemistry. C57BL/6 mice were randomly divided into 3 groups: healthy control group, ARP model group, and DXM + GM enema treatment group. ARP mice were established by using a single 6 MV X-ray dose of 27 Gy pelvic local irradiation. Transcriptome sequencing results showed that 979 genes were co-upregulated and 445 genes were co-downregulated in ARP mice compared to healthy mice. According to gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis, we firstly found that PI3K/AKT/NF-κB/VEGF pathways were mostly correlated with the inflammation-induced angiogenesis in ARP mice. PI3K/AKT pathway leads to the activation of NF-κB, which promotes the transcription of VEGF and Bcl-2. Interestingly, symptoms and pathological changes of ARP mice were ameliorated by DXM + GM enema treatment. DXM + GM enema inhibited inflammation by downregulating NF-κB and upregulating AQP3, as well as inhibited angiogenesis by downregulating VEGF and AQP1 in ARP mice. Moreover, DXM + GM enema induced apoptosis by increasing Bax and suppressing Bcl-2. The novel mechanisms may be related to the downregulation of PI3K/AKT/NF-κB/VEGF pathways.

• Cystitis
• Hyperbaric oxygen therapy
• Osteoradionecrosis
• Proctitis
• Radiation induced

• Humans
• Hyperbaric Oxygenation/adverse effects
• Hyperbaric Oxygenation/methods
• Neoplasms/complications
• Neoplasms/radiotherapy
• Proctitis/complications
• Proctitis/therapy
• Quality of Life
• Radiation Injuries/etiology
• Radiation Injuries/therapy
• Retrospective Studies

• Hyperbaric oxygen treatment
• Pelvic malignancies
• Pelvic radiotherapy
• Quality of life
• Side effects

• Anal cancer
• anal cancinoma
• guideline
• late adverse effects
• late toxicity

Radiotherapy (RT) is a treatment modality that uses high-energy rays or radioactive agents to generate ionizing radiation against rapidly dividing cells. The main objective of using radiation in cancer therapy is to impair or halt the division of the tumor cells. Over the past few decades, advancements in technology, the introduction of newer methods of RT, and a better understanding of the pathophysiology of cancers have enabled physicians to deliver doses of radiation that match the exact dimensions of the tumor for greater efficacy, with minimal exposure of the surrounding tissues. However, RT has numerous complications, the most common being radiation proctitis (RP). It is characterized by damage to the rectal epithelium by secondary ionizing radiation. Based on the onset of signs and symptoms, post-radiotherapy RP can be classified as acute or chronic, each with varying levels of severity and complication rates. The treatment options available for RP are limited, with most of the data on treatment available from case reports or small studies. Here, we describe the types of RT used in modern-day medicine and radiation-mediated tissue injury. We have primarily focused on the classification, epidemiology, pathogenesis, clinical features, treatment strategies, complications, and prognosis of RP.

• Colorectal Neoplasms
• Proctitis
• Radiation
• Rectum

• Anal cancer
• Cancer de l’œsophage
• Cancer du anal
• Cancer gastrique
• Cancer pancréatique
• Cancer rectal
• Enteritis
• Entérite
• Fistulae
• Fistule
• Gastric cancer
• Liver tumor
• Oesophageal cancer
• Pancreatic cancer
• Perforation
• RILD
• Radiation therapy
• Radiothérapie
• Rectal cancer
• Stenosis
• Sténose
• Tumeur hépatique

• Argon plasma coagulation
• Argon plasma coagulation-induced rectal ulcer
• Chronic radiation proctitis
• Hyperbaric oxygen therapy

• Delayed radiation injury
• Hyperbaric oxygen
• Hyperbaric oxygen therapy
• Late radiation tissue injury
• Late sequelae
• Radiation proctitis
• Radiation proctopathy
• Radio-induced lesion
• Radiotherapy
• Review

• Humans
• Hyperbaric Oxygenation
• Neoplasms
• Proctitis/diagnosis
• Proctitis/etiology
• Proctitis/therapy
• Prospective Studies
• Radiation Injuries/diagnosis
• Radiation Injuries/etiology
• Radiation Injuries/therapy

• Endoscopy
• Radiation
• Stricture

• Brachytherapy
• Low dose-rate
• Prostate cancer
• Technical challenges
• Toxicity

• Anti-Bacterial Agents/administration & dosage
• Combined Modality Therapy/methods
• Debridement
• Female
• Genital Neoplasms, Female/radiotherapy
• Humans
• Hydrogen Peroxide/administration & dosage
• Hyperbaric Oxygenation
• Incidence
• Necrosis/diagnosis
• Necrosis/epidemiology
• Necrosis/etiology
• Necrosis/therapy
• Radiation Injuries/diagnosis
• Radiation Injuries/epidemiology
• Radiation Injuries/etiology
• Radiation Injuries/therapy
• Radiotherapy Dosage
• Risk Factors
• Treatment Outcome
• Vagina/pathology
• Vagina/radiation effects
• Vagina/surgery
• Vaginal Douching/methods

• R01 CA237005 NCI NIH HHS

• Brachytherapy
• Cervical cancer
• Complications
• Endometrial cancer
• Gynecologic cancer
• Intracavitary

• angiodysplasia
• anorectal disorders
• endoscopy
• gastrointestinal bleeding
• radiation enteritis

Cancer survival rates have significantly improved over the last number of years due to advancements in cancer therapies. Unfortunately this has come at a cost. Therapeutic side effects are feared complications of therapy that may result in decreased quality of life and early cessation of the therapy, which can have knock-on effects on outcomes. This article outlines the main gastrointestinal side effects seen with radiation therapy, chemotherapy and immunotherapy, and discusses appropriate investigation and management.

• Cancer
• Chemotherapy
• Colitis
• Enteritis
• Gastrointestinal side effects
• Hepatitis
• Immunotherapy
• Proctitis
• Radiotherapy
• Typhilitis

Breast cancer treatment with radiotherapy can induce late radiation toxicity, characterized by pain, fibrosis, edema, impaired arm mobility, and poor cosmetic outcome. Hyperbaric oxygen therapy (HBOT) has been proposed as treatment for late radiation toxicity; however, high-level evidence of effectiveness is lacking. As HBOT is standard treatment and reimbursed by insurers, performing classic randomized controlled trials is difficult. The “Hyperbaric OxygeN therapy on brEast cancer patients with late radiation toxicity” (HONEY) trial aims to evaluate the effectiveness of HBOT on late radiation toxicity in breast cancer patients using the trial within cohorts (TwiCs) design.

The HONEY trial will be conducted within the Utrecht cohort for Multiple BREast cancer intervention studies and Long-term evaluation (UMBRELLA). Within UMBRELLA, breast cancer patients referred for radiotherapy to the University Medical Centre Utrecht are eligible for inclusion. Patients consent to collection of clinical data and patient-reported outcomes and provide broad consent for randomization into future intervention studies. Patients who meet the HONEY in- and exclusion criteria (participation ≥ 12 months in UMBRELLA, moderate/severe breast or chest wall pain, completed primary breast cancer treatment except hormonal treatment, no prior treatment with HBOT, no contraindications for HBOT, no clinical signs of metastatic or recurrent disease) will be randomized to HBOT or control group on a 2:1 ratio (n = 120). Patients in the control group will not be informed about participation in the trial. Patients in the intervention arm will undergo 30–40 HBOT treatment sessions in a high pressure chamber (2.4 atmospheres absolute) where they inhale 100% oxygen through a mask. Cohort outcome measures (i.e., physical outcomes, quality of life, fatigue, and cosmetic satisfaction) of the HBOT group will be compared to the control group at 3 months follow-up.

This pragmatic trial within the UMBELLA cohort was designed to evaluate the effectiveness of HBOT on late radiation toxicity in breast cancer patients using the TwiCs design. Use of the TwiCs design is expected to address issues encountered in classic randomized controlled trials, such as contamination (i.e., HBOT in the control group) and disappointment bias, and generate information about acceptability of HBOT.

ClinicalTrials.gov. NCT04193722. Registered on 10 December 2019.

The online version contains supplementary material available at 10.1186/s13063-020-04869-z.

• Breast cancer
• Hyperbaric oxygen therapy
• Late toxicity
• Patient-reported outcomes
• Radiotherapy
• Trials within cohorts

• Damage
• Gastritis
• Gastrointestinal
• Gastrointestinal bleeding
• Oesophagitis
• Radiation
• Ulcers

• Endoscopic treatment
• Medical treatment
• Radiation enteritis
• Radiation proctitis

• Cancer
• Endothelium
• Gastro-intestinal tract
• Genito-urinary tract
• Pain
• Soft-tissue radionecrosis

• Radiation enteritis
• Radiotherapy
• Small bowel iterative resections

Changrui enema, a traditional Chinese medicine prescription, is used as a supplementary treatment for acute radiation proctitis (ARP). Herein we explored the inhibition effects of Changrui enema on NF-κB and VEGF in ARP mice.

A total of 120 C57BL/6 mice were divided randomly into normal mice group, ARP mice group, western medicine enema group (dexamethasone combined with gentamicin), and Changrui enema group. ARP mice were established by pelvic local irradiation. The expression of IL-1β, NF-κB, VEGF, AQP1, AQP3, p-ERK1/2 and p-JNK was determined by immunohistochemistry or western blot.

The study firstly found that Changrui enema alleviated ARP mice. The expression of IL-1β, NF-κB, VEGF, AQP1 and p-ERK1/2 was increased in ARP mice, and was reserved by Changrui enema. However, the expression of AQP3 and p-JNK was decreased in ARP mice, and was up-regulated by Changrui enema.

Changrui enema is an effective treatment with fewer side effects for ARP. The mechanism of Changrui enema may be related to the inhibition of inflammation-induced angiogenesis. Changrui enema inhibits IL-1β and NF-κB expression as well as VEGF expression. Interestingly, AQP1 promotes angiogenesis, while AQP3 inhibits inflammation. Changrui enema probably inhibits AQP1 expression by down-regulating p-ERK1/2, and improves AQP3 expression by up-regulating p-JNK.

Sarcomas are commonly managed by surgical resection combined with radiotherapy. Sarcoma treatment is frequently complicated by chronic wounds and late radiation tissue injury (LRTI). This study aims to gain insight in the use and results of hyperbaric oxygen therapy (HBOT) for radiation-induced complications following sarcoma treatment.

All sarcoma patients treated between 2006 and 2017 in one of the five centers of the Institute for Hyperbaric Oxygen in the Netherlands were included for retrospective analysis.

Thirty patients were included, 18 (60.0%) patients were treated for chronic wounds and 12 (40.0%) for LRTI. Two patients with chronic wounds were excluded from analysis as HBOT was discontinued within five sessions. In 11 of 16 (68.8%) patients treated for chronic wounds, improved wound healing was seen. Nine of 12 (75.0%) patients treated for LRTI reported a decline in pain. Reduction of fibrosis was seen in five of eight patients (62.5%) treated for LRTI.

HBOT is safe and beneficial for treating chronic wounds and LRTI in the sarcoma population. Awaiting further prospective results, we recommend referring to HBOT centers more actively in patients experiencing impaired wound healing or symptoms of delayed radiation-induced tissue injury following multimodality sarcoma treatment.

• diarrhea
• hyperbaric oxygen
• pain
• pelvic radiotherapy
• rectal bleeding

• Anal cancer
• Surveillance
• Survivorship
• Toxicity

• Anus Neoplasms/diagnosis
• Anus Neoplasms/epidemiology
• Anus Neoplasms/etiology
• Anus Neoplasms/therapy
• Chemoradiotherapy/adverse effects
• Chemoradiotherapy/methods
• Disease Management
• Female
• Humans
• Incidence
• Magnetic Resonance Imaging/methods
• Male
• Models, Theoretical
• Patient Care/statistics & numerical data
• Public Health Surveillance
• Sexual Dysfunction, Physiological/etiology
• Sexual Health
• Survivorship

Chronic radiation proctitis (CRP) is a complication which occurs in 1%-5% of patients who undergo radiotherapy for pelvic malignancies. Although a wide range of therapeutic modalities are available, there is no literature to date showing any particularly appropriate therapeutic modality for each disease stage. Argon plasma coagulation (APC) is currently recommended as the first-choice treatment for hemorrhagic CRP, however, its indication based on long-term follow-up is still unclear. On the hypothesis that the long-term efficacy and safety of APC are not fully understood, we reviewed APC treatment for patients with hemorrhagic CRP from a single center.

To assess the long-term efficacy and safety of APC for hemorrhagic CRP.

This is a retrospective study of consecutive patients treated with APC for hemorrhagic CRP from January 2013 to October 2017. Demographics, clinical variables, and typical endoscopic features were recorded independently. Success was defined as either cessation of bleeding or only occasional traces of bloody stools with no further treatments for at least 12 mo after the last APC treatment. We performed univariate and multivariate analyses to identify factors associated with success and risk factors for fistulas.

Forty-five patients with a median follow-up period of 24 mo (range: 12-67 mo) were enrolled. Fifteen (33.3%) patients required blood transfusion before APC. Successful treatment with APC was achieved in 31 (68.9%) patients. The mean number of APC sessions was 1.3 (1-3). Multivariate analysis showed that APC failure was independently associated with telangiectasias present on more than 50% of the surface area [odds ratio (OR) = 6.53, 95% confidence interval (CI): 1.09-39.19, P = 0.04] and ulcerated area greater than 1 cm² (OR = 8.15, 95%CI: 1.63-40.88, P = 0.01). Six (13.3%) patients had severe complications involving rectal fistulation. The only factor significantly associated with severe complications was ulcerated area greater than 1 cm² (P = 0.035).

The long-term efficacy of APC for hemorrhagic CRP is uncertain in patients with telangiectasias present on > 50% of the surface area and ulceration > 1 cm².

• Argon plasma coagulation
• Chronic radiation proctitis
• Radiation proctopathy
• Efficacy
• Safety

• Adult
• Aged
• Aged, 80 and over
• Argon Plasma Coagulation/adverse effects
• Female
• Follow-Up Studies
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/surgery
• Humans
• Intestinal Mucosa/blood supply
• Intestinal Mucosa/pathology
• Intestinal Mucosa/radiation effects
• Intestinal Mucosa/surgery
• Male
• Middle Aged
• Pelvic Neoplasms/radiotherapy
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Proctitis/etiology
• Proctitis/pathology
• Proctitis/surgery
• Radiation Injuries/etiology
• Radiation Injuries/pathology
• Radiation Injuries/surgery
• Rectum/blood supply
• Rectum/pathology
• Rectum/radiation effects
• Rectum/surgery
• Retrospective Studies
• Risk Factors
• Telangiectasis/etiology
• Telangiectasis/pathology
• Telangiectasis/surgery
• Treatment Outcome

• Dose-response relationship
• Humans
• Male
• Prostatic neoplasms
• Radiation
• Radiation injuries/etiology
• Radiotherapy/adverse effects
• Survivorship
• Treatment outcome

• Endoscopic therapy
• Medical therapy
• Radiation proctitis
• Surgical therapy