Guidelines for Complications of Cancer Treatment Vol VIII Part B

adiation therapy), IMRT (intensity-modulated radiotherapy)techniques, simultaneous integrated IMRT boost, protontherapy etc which allows precise delivery and dose escalationof radiation while sparing the neighboring normal tissues and,b) Biological method, wherein treatment is delivered over time(fractionation), allowing the sparing of late normal tissuetoxicity; combining radiation with chemotherapy or targetedagents so as to overcome the repopulation and radio-resistanceof hypoxic tumors.With the above advances in treatment strategies, have thepotential in further improvements in survival and probablyreduction in late sequelae. However, till date there is nosubstantial data including late toxicities to support. Thesecomplications are a trade-off in the pursuit to cure pelvicmalignancies. Thus it has become imperative that the radiationoncologist is aware of the patho-physiology and the treatmentoptions for these patients who manifest the complications. Onrecognition of problems, referral pathways should be laid suchthat the suffering patient can see a specialist.Summary and ConclusionsTo summarize, patients receiving abdomino-pelvic radiationwill encounter acute grade I-III gastro-intestinal, genitourinaryand skin toxicities which are treatable. The radiation inducedlate sequelae are preventable. This needs careful selection ofcases, appropriate and optimum radiation planning (externaland / or brachytherapy), limiting doses to adjacent criticalorgans / tissues, careful follow-up evaluation to identifytoxicities at the earliest and immediate appropriate treatmentmeasures. In order to achieve this apart from the RadiationOncologist and the treating team and other members of themulti-disciplinary team (Surgical and Medical Oncologist)should be aware of the anticipated effects following radiationtherapy and the knowledge that timely intervention would toa large extent abort them.276