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Chronisch entzündliche Darmerkrankungen (CED)

Literature on radiation sensitivity in IBD

Chronic inflammatory bowel diseases include Crohn's disease and ulcerative colitis. These diseases are caused by a faulty immune response that leads to inflammation in the bowel. Symptoms include diarrhoea and abdominal pain. Overview of IBD
Earlier studies found that radiation led to increased inflammation in the bowel. However, more recent trials using more modern radiotherapy techniques have shown less toxicity. There are currently no guidelines for the use of radiotherapy in patients with IBD. However, radiotherapy outside of an acute flare may prevent toxicities. Radiation therapy in patients with inflammatory bowel disease.  There is also evidence of a 2-fold increase in relapse rates in patients with IBD after radiotherapy for prostate cancer within one year. Rates of Adverse IBD-Related Outcomes for Patients With IBD and Concomitant Prostate Cancer Treated With Radiation Therapy.
Patients with IBD who received radiotherapy for rectal cancer developed more lower gastrointestinal toxicities, and at the same time the survival of patients with the more aggressive IBD tumours was as good as in the control group. Both suggest an increased sensitivity to radiation. Radiation therapy in patients with inflammatory bowel disease and colorectal cancer: Risks and benefits.

A rare case has shown that radiotherapy for prostate cancer can cause ulcerative colitis. This must be considered in the differential diagnosis of radiation-induced colitis. Ulcerative colitis that developed during radiotherapy for prostate cancer, deteriorated rapidly and required emergency surgery.
Finally, patients with IBD should not be excluded from radiotherapy in advance. It is important to consider the individual patient, the severity of the disease, the inflammatory activity and the proportion of the irradiated field in relation to the affected bowel segment. Should inflammatory bowel disease be a contraindication to radiation therapy.

Conclusion

In any case, inflammatory tissue appears to be more sensitive to radiation and should be spared as much as possible by modern radiotherapy techniques. It is not clear whether there is also a general increase in radiation sensitivity.