Radiation Oncology: Modern Review of Treatment Toxicity

Main Article Content

Kevin O’Connor, BS James Shen, BS Ameer Elaimy, PhD Linda Ding, PhD John Roubil, BA Kara Benson, BA Julie Trifone, RT (T) CMD Maureen Britton, RN, CMD Carla Bradford, PhD I-Lin Kuo, PhD Yankua Fan, PhD Fenghong Liu, PhD Suhong Lu, PhD Harry Bushe, MS Jonathan Saleeby, MS Abdulnasser Khalifeh, PhD Camelia Bunaciu, MSc Maryann Bishop, MS Thomas J. FitzGerald, MD


Radiation therapy has undergone an extraordinary transformation in treatment technology. Daily patient care is vastly different today than the past with less normal tissue in the treatment field and fewer acute sequelae during and immediately post therapy. It is anticipated that modern therapy will decrease acute effects during treatment. Modern primary care physicians and internal medicine/emergency physicians will encounter more patients in their practice who are survivors of therapy. In this paper we review current expectations for clinical sequelae of management and strategies to both identify and manage treatment effects moving forward including what is needed in the medical record for evaluation of late effects.

Article Details

How to Cite
O’CONNOR, Kevin et al. Radiation Oncology: Modern Review of Treatment Toxicity. Medical Research Archives, [S.l.], v. 9, n. 7, july 2021. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2491>. Date accessed: 27 may 2024. doi: https://doi.org/10.18103/mra.v9i7.2491.
Research Articles


1. Withers HR, Taylor JM, Maciejewski B. Treatment volume and tissue tolerance. Int J Radiat Oncol Biol Phys. 1988;14(4):751-759.
2. Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991;21(1):109-122.
3. Niemierko A. A generalized concept of Equivalent Uniform Dose (EUD). Med Phys. 1999;26(6)1100.
4. Bentzen SM, Constine LS, Deasy JO, et al. Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): an introduction to the scientific issues. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S3-9.
5. Marks LB, Yorke ED, Jackson A, et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S10-9.
6. Kalapurakal JA, Gopalakrishnan M, Walterhouse DO, et al. Cardiac-sparing whole lung IMRT in patients with pediatric tumors and lung metastasis: Final report of a prospective multicenter clinical trial. Int J Radiat Oncol Biol Phys. 2019;103(1):28-37.
7. Mendenhall NP, Fitzgerald TJ. Conventional radiation therapy compared with stereotactic conformal therapy-A rare and laudable randomized trial. JAMA Oncol. 2017;3(10):1376-1377.
8. Ding Z, Zhang H, Lv X-F, et al. Radiation-induced brain structural and functional abnormalities in presymptomatic phase and outcome prediction. Hum Brain Mapp. 2018;39(1):407-427.
9. Lin J, Lv X, Niu M, et al. Radiation-induced abnormal cortical thickness in patients with nasopharyngeal carcinoma after radiotherapy. Neuroimage Clin. 2017;14:610-621.
10. Peters LJ, O’Sullivan B, Giralt J, et al. Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck cancer: results from TROG 02.02. J Clin Oncol. 2010;28(18):2996-3001.
11. Yusuf SW, Venkatesulu BP, Mahadevan LS, Krishnan S. Radiation-induced cardiovascular disease: A clinical perspective. Front Cardiovasc Med. 2017;4:66.
12. Darby SC, Ewertz M, McGale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368(11):987-998.
13. Kwa SL, Lebesque JV, Theuws JC, et al. Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients. Int J Radiat Oncol Biol Phys. 1998;42(1):1-9.
14. Graham MV. Predicting radiation response. Int J Radiat Oncol Biol Phys. 1997;39(3):561-562.
15. Graham MV, Purdy JA, Emami B, et al. Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys. 1999;45(2):323-329.
16. Hanania AN, Mainwaring W, Ghebre YT, Hanania NA, Ludwig M. Radiation-induced lung injury: Assessment and management. Chest. 2019;156(1):150-162.
17. Käsmann L, Dietrich A, Staab-Weijnitz CA, et al. Radiation-induced lung toxicity - cellular and molecular mechanisms of pathogenesis, management, and literature review. Radiat Oncol. 2020;15(1):214.
18. Dawson LA, McGinn CJ, Normolle D, et al. Escalated focal liver radiation and concurrent hepatic artery fluorodeoxyuridine for unresectable intrahepatic malignancies. J Clin Oncol. 2000;18(11):2210-2218.
19. Dawson LA, Ten Haken RK, Lawrence TS. Partial irradiation of the liver. Semin Radiat Oncol. 2001;11(3):240-246.
20. Baradaran-Ghahfarokhi M. Radiation induced kidney injury. J Ren Inj Prev. 2021;1(2):49-50.
21. Lukez A, O’Loughlin L, Bodla M, Baima J, Moni J. Positioning of port films for radiation: variability is present. Med Oncol. 2018;35(5):77.
22. Oh D, Huh SJ. Insufficiency fracture after radiation therapy. Radiat Oncol. 2014;32(4):213-220.

Most read articles by the same author(s)