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Beyond Tumor Control: Radiation-Induced Ascites as a Rare Complication in Gastric Cancer Management
Vahid Mohammadkarimi1, Abolfazl Khalafi-Nezhad1, Nazanin Alemzadeh1
1Department of Hematology, Medical Oncology and Stem Cell Transplantation, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran, sums.ac.ir.
Case Reports in Oncological Medicine
|June 29, 2026
Summary
Radiation-induced ascites is a rare complication after gastric cancer treatment. This case highlights the diagnostic challenge and the need for vigilance in post-radiotherapy patients.
Area of Science:
- Oncology
- Gastroenterology
- Radiation Oncology
Background:
- Gastric cancer is a major cause of cancer mortality globally.
- Treatment involves surgery, chemotherapy, and radiotherapy.
- Ascites is a rare but potential complication of these treatments.
Purpose of the Study:
- To present a rare case of radiation-induced ascites following gastric cancer treatment.
- To discuss the diagnostic challenges and exclusion criteria for this condition.
- To emphasize the importance of clinical vigilance and further research.
Main Methods:
- A 51-year-old male with gastric adenocarcinoma received chemotherapy, resection, and adjuvant radiotherapy.
- Ascites developed post-radiotherapy; diagnosis was made by excluding other causes (e.g., portal hypertension, infection, malignancy).
- Diagnostic tools included paracentesis, SAAG, PMN count, adjunctive markers, PET imaging, and laparoscopy with biopsies.
Main Results:
- The patient developed acute ascites after radiotherapy.
- Ascitic fluid analysis showed non-chylous fluid with high protein and lymphocytic predominance.
- All common causes of ascites were excluded, and no tumor recurrence was found.
- Ascites resolved after a single paracentesis without recurrence.
Conclusions:
- Radiation-induced ascites is a diagnosis of exclusion due to its rarity and lack of specific biomarkers.
- Proposed mechanisms involve endothelial injury and microthrombotic changes.
- Clinical vigilance is crucial for identifying this complication, and further studies are needed to find biomarkers and optimize radiotherapy planning.
