Surgical Prevention and Treatment of Late Normal Tissue Injury

There is a definite increase in combined-modality treatment of malignancies. Surgery, radiation therapy and/or chemotherapy often are combined. A disadvantage is the increased risk for short- and long-term complications, especially radiation-induced damage to normal healthy tissue such as intestine and bone. Brachytherapy and intraoperative radiotherapy are new radiation techniques with the potential to increase the radiation dose to the tumor while reducing the radiation dose to surrounding normal tissues. The surgical transposition of organs outside the pathway of the ionizing beam is a new surgical technique often used in the pelvis. Radiation damage to the gastrointestinal tract is often mentioned. Fibrosis and obstruction may occur as a result of stricture formation or fibrinous adhesions. Ischemic necrosis of the bowel wall may lead either to perforation or fistulae. Mucosal damage and lymphatic obstruction can cause malabsorption. These complications are difficult to manage and should be treated in specialized centers.