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Oncology
incidence of bowel obstruction of 9.5, 13 and 17% at five, 10 and 15 patients with grade 0, 1, 2 and 3 side effects depending on the maximal
years, respectively. All children underwent abdominal surgery prior to radiation dose to the bowel. There are only three patients with grade 3
radiotherapy. In two cases, small bowel obstruction was primarily toxicity. All of them were irradiated with doses exceeding 50Gy to the
attributed to the initial surgery. The other four patients had small bowel bowel. Two of these patients (one each with a Ewing tumour and a
obstruction at nine to 158 months after nephrectomy and post-operative rhabdomyosarcoma) had a tumour-associated ileus prior to radiotherapy
radiotherapy. Hemi-abdominal or whole abdomen radiotherapy was and a second ileus after radiotherapy. The other patient had an additional
performed with doses <12Gy in two cases; the other four patients flab brachytherapy with an unknown radiation dose to the bowel. In
received doses up to 40Gy. The most common cause of an obstruction
was a bowel adhesion. The use of radiotherapy was not found to
increase the incidence of small bowel obstruction. Ritchey et al.
8
reported
the rate of small bowel obstruction after nephrectomy for Wilms’
Prospective trials with detailed
tumour. Among 1,910 children, 131 (6.9%) developed small bowel
information regarding organ
obstruction. Several factors influenced this rate (e.g. higher local tumour
dose–volume paramaters of radiation
stage), but the incidence of post-operative small bowel obstruction was
not increased in children who received post-operative radiation therapy are needed.
in comparison with those without radiation. Radiation therapy was
randomised for stage II (0 versus 20Gy) and stage III (10 versus 20Gy)
patients with favourable histology. Within the first group, 6.1% of patients with grade 2 toxicity there was also one patient (with a Ewing
patients (9/139) without radiation and 9.2% of patients (12/112) with tumour) with additional flab brachytherapy. One patient with a clear cell
radiation developed small bowel obstruction (not significant). Within the sarcoma experienced a bowel paralysis due to vincristine chemotherapy.
second group, 11 of 122 (8.3%) patients with radiation therapy of 10Gy
and 16 of 127 (11.3%) patients with radiation therapy of 20Gy Taken together, these preliminary results show a trend towards a dose-
developed small bowel obstruction (not significant). There were only effect relationship in bowel toxicity after radiation. However, further
three children in whom the surgeon described operative findings of influences such as abdominal surgery and chemotherapy will have to be
radiation enteritis. There are no detailed data regarding the rate of late included in the analysis later.
gastrointestinal complications after abdominal radiotherapy depending
on the radiation doses at the bowel in children. Conclusion
Late sequelae after radiotherapy in children and adolescents are observed
fairly frequently, and some dose–effect relationships have already been
With prolongation and completion
described. However, prospective trials with detailed information
of the follow-up data, RiSK will be
regarding organ dose–volume paramaters of radiation are needed. A
further collection of treatment data and a longer follow-up period of
able to provide detailed information
toxicity documentation in RiSK will lead to detailed analyses of the organ
regarding dose–volume-associated
dose–effect relationship. To further increase the number of patients in
order to obtain faster results, international co-operation with other study
late sequelae of the lungs.
groups evaluating radiation-associated side effects after radiotherapy in
childhood and adolescence is welcome. ■
Within the RiSK database there are 86 patients who had radiation to parts
of the bowel and who have been followed regarding toxicity. The median Acknowledgements
age at radiotherapy was 11.3 years (0.75–28 years) with a median follow- The Registry for the Evaluation of Late Side Effects After Radiotherapy in
up of 15 months (2–63 months). The radiation dose at the bowel was Childhood and Adolescence (RiSK) is supported by the German Children’s
median 36Gy with a range of 2–60Gy. Figure 2 shows the number of Cancer Foundation, Bonn, Germany.
1. Ries LAG, Smith MA, Gurney JG, et al., editors. Cancer survivors of childhood and adolescent cancer. A report from 12. Abid SH, Malhotra V, Perry MC, Radiation-induced and
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42 EUROPEAN PAEDIATRICS
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