Radiation enteritis in children.A retrospective review, clinicopathologic correlation, and dietary management

Abstract

The clinicopathologic features of radiation enteritis are reviewed in 44 children receiving whole abdominal radiation therapy between 1961–1972 at the Institut Gustave‐Roussy. Five of 14 long‐term survivors (36%) developed severe delayed radiation injury with small bowel obstruction, occurring within 2 months after completion of irradiation. All had previously had acute radiation reaction during therapy. Histologic appearance in the small bowel at the time of delayed radiation injury revealed severe villus blunting, lymphatic dilatation, and moderately dense inflammatory infiltrate. All patients with delayed radiation injury showed marked clinical improvement coincident with a fractionated low‐residue, low‐fat diet, free of gluten and free of milk and milk products. The abnormal small bowel roentgenographs and small bowel biopsies reverted to a normal appearance in association with the diet. No exacerbation of radiation enteritis has been seen following dietary therapy.

Role of nutritional intervention in patients treated with radiotherapy for pelvic malignancy

“…Low-fat diet (uncontrolled) or low fat with bile acid sequestrant (Bosaeus et al, 1979;Danielsson et al, 1991). Gluten and cow's milk protein free with additional lactose and reduced fat/residue (Donaldson et al, 1975). Parenteral nutrition support (Haddad et al, 1974;Miller et al, 1979;Lavery et al, 1980;Silvain et al, 1992;Scolapio et al, 2002).…”

“…A gluten-free, cow's milk protein-free, low-residue and low-fat diet was implemented in children with severe radiation enteritis following pelvic irradiation (Donaldson et al, 1975). The five case reports suggested that malabsorption and overall nutritional status could be improved with this dietary intervention.…”

“…These may include urgency, frequency, faecal incontinence, diarrhoea, steatorrhoea, tenesmus, pain, constipation and weight loss . The severity of acute bowel toxicity may predetermine the degree of chronic bowel changes (Donaldson et al, 1975). Therefore, early intervention to prevent or reduce acute toxicity may be worthwhile in the long term.…”

Childhood cancer survivors: Considerations for surgeons in the transition from pediatric to adult care

“…12 Bowel obstructions are also well documented after staging laparotomy or splenectomy for Hodgkin lymphoma (HL), although these surgeries are no longer routine elements of HL care. 13,14 Bowel obstruction risk is further increased in patients who receive abdominal RT, which has been associated with chronic enterocolitis 15 and strictures. Radiation tolerance is influenced by both the dose and the volume of bowel in the radiation field.…”

The nutritional effects of cancer and its therapy

“…In one study, children received radiation and chemotherapy to the abdominal-pelvic area for treatment of malignant disease; 55 % lost weight during treatment, 70% developed acute enteritis, and 36% developed chronic enteritis presenting as small bowel obstruction. 27 Clinicians must take into account such enhanced tissue injury with its expected nutritional sequelae when planning therapy.…”