THE PREVENTION OF RADIATION-INDUCED SMALL-BOWEL COMPLICATIONS

Moderate dose pelvic radiotherapy is associated with a 5% severe compl ication risk related to the small bowel. Strictures and/or fistulation can occur many years after treatment. These complications are difficu lt to treat, and surgical treatment (excision, bypass) bears a signifi cant morbidity risk. The risk of chronic diarrhoea or malabsorption ma y increase to 40%, depending on the irradiated small bowel volume. Lat e small bowel complications are generally irreversible due to vascular aetiology. Prevention of these complications can be achieved by limit ing the volume of small bowel treated. Consequences for radiotherapeut ic techniques in treatment for rectal cancer are multiple beam set-up, customised blocking based on visualisation of the small bowel in the treatment position, and the use of a special open table-top device tha t results in a small bowel shift from the treatment field.