Intestinal complications of wide field abdominal irradiation for lymphoma

We report bowel complications on a series of 32 patients treated with wide field abdominal irradiation for lymphoma between 1979 and 1983. Irradiation was preceded by chemotherapy in 30/32 patients. Fifteen of the 32 patients received total abdominal irradiation and 17/32 received upper hemi-abdominal irradiation to a dose of 20-25 Gy. A boost of 5-20 Gy to a reduced volume was added in 14/32. A special diet was prescribed from the start of irradiation. Immediate tolerance to irradiation was good in 94% of patients. Only five patients developed delayed bowel complications. Definite radiation-induced bowel changes were demonstrated in only two of these cases and other pathology was found to explain the symptomatology in the remaining three. Comparison with a previous series of 50 lymphoma patients treated with total abdominal irradiation to 30 Gy plus inverted Y boost to 10 Gy demonstrated a net improvement in the immediate tolerance and reduction in the incidence and gravity of delayed radiation-related bowel complications in the current series. The reasons for the improved early and late bowel tolerance (radiation dose and volume, etc.) as well as conditions which can mimic late radiation enteritis, will be discussed.