Management of gastrointestinal perforation related to radiation

Perforation of gastrointestinal (GI) tract is a rare, but serious complication of abdominopelvic irradiation, and it can even occur several years after radiotherapy. As one of the symptoms of radiation enteropathy, it shares common features with other chronic complications and has its own characteristic at the same time. It has been reported that some systematic therapies, such as sorafenib and bevacizumab, could add the risk of radiation-induced GI perforation. The potential mechanisms of aggravated GI injury may be exacerbation of epithelial cell damage, microvascular damage or subsequent inflammatory response. The complicated situation makes it almost impossible to set uniform dose constraints for GI perforation prevention. The majority of cancer patients with GI perforation require emergency surgery, and there is no high quality evidence for supporting the use of any prevention measures. In this review, we summarize the clinical manifestation, risk factors, mechanism, and therapy of radiation-induced GI perforation. A comprehensive treatment plan is crucial to improve the quality of life for cancer survivors.