Prevention and management of radiotherapy-related toxicities in gynecological malignancies - Position paper on behalf of AIRO

Sep 21, 2026

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Multi-modal therapies for gynecological cancers can produce a broad spectrum of side effects shaped by treatment-related factors and patient comorbidities. Curative or adjuvant pelvic radiotherapy is associated with acute and late toxicity from irradiation of organs at risk, including bowel, rectum, bladder, pelvic bone, vagina, and bone marrow. Effective management depends on severity and the radiation oncology team’s practice and skills, and is supported by evidence-based strategies and follow-up recommendations from AIRO’s position paper.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages23

Reading Time58 min

AccessFree to download

Abstract

Introduction

Results

Bowel toxicity

Incidence and etiopathogenesis

Methods

La radiologia medica (2024) 129:1329–1351 [https://doi.org/10.1007/s1](https://doi.org/10.1007/s1) 1547-024-01844-5 Prevention and management of radiotherapy‑related toxicities in gynecological malignancies. Position paper on behalf of AIRO (Italian Association of Radiotherapy and Clinical Oncology) Elisabetta Perrucci1 · Gabriella Macchia2 · Annamaria Cerrotta3 · Angela Damiana Andrulli4 · Rosa Autorino5 · Amelia Barcellini6,7 · Maura Campitelli5 · Giulia Corrao8 · Sara Costantini9 · Vitaliana De Sanctis10 · Jacopo Di Muzio11 · Valeria Epifani12 · Patrizia Ferrazza13 · Andrei Fodor14 · Elisabetta Garibaldi15 · Concetta Laliscia16 · Roberta Lazzari8 · Elena Magri17 · Cristina Mariucci18 · Maria Paola Pace19 · Brigida Pappalardi20 · Alice Pastorino21 · Federica Piccolo22 · Claudio Scoglio23 · Alessia Surgo24 · Francesca Titone25 · Francesca Tortoreto26 · Francesca De Felice27 · Cynthia Aristei28 Received: 7 March 2024 / Accepted: 1 July 2024 / Published online: 28 August 2024 © The Author(s) 2024 Abstract Multi-modal therapies for gynecological cancers management may determine a wide range of side effects which depend on therapy-related factors and patient characteristics and comorbidities. Curative or adjuvant pelvic radiotherapy is linked with acute and late toxicity due to irradiation of organs at risk, as small and large bowel, rectum, bladder, pelvic bone, vagina and bone marrow. Successful toxicity management varies with its severity, Radiation Centre practice and experience and skills of radiation oncologists. This position paper was designed by the Italian Association of Radiation and Clinical Oncology Gynecology Study Group to provide radiation oncologists with evidence-based strategies to prevent and manage acute and late toxicities and follow-up recommendations for gynecological cancer patients submitted radiotherapy. Six workgroups of radiation oncologists with over 5 years of experience in gynecologic cancers were setup to investigate radiotherapyrelated toxicities. For each topic, PubMed database was searched for relevant English language papers from January 2005 to December 2022. Titles and abstracts of results were checked to verify suitability for the document. Reference lists of selected studies and review papers were added if pertinent. Data on incidence, etiopathogenesis, prevention, treatment and follow-up of acute and late side effects for each organ at risk are presented and discussed. Keywords Gynecological cancers · Radiotherapy · Acute late toxicity · Prevention · Treatment · Follow-up Introduction Today’s multi-modal therapies for gynecological cancers management including surgery, chemotherapy (CHT), external beam radiotherapy (EBRT) and interventional radiotherapy (IR), also called brachytherapy, may determine a wide range of underestimated side effects [1, 2], the development of which depends on therapy-related factors such as radiation therapy (RT) modality and dose, and patient characteristics and comorbidities. Pelvic RT, in the curative or adjuvant setting, is linked with acute and late toxicity due to irradiation of organs at risk (OARs), such as the small and large bowel, rectum, bladder, and femoral heads, Extended author information available on the last page of the article and can cause detrimental effects on health and long-term quality of life (QoL) [1, 2] . More recently further toxicities emerged, as hematological, due to the widespread use of concomitant chemoradiation (CRT), and pelvic bone and vaginal side effects [2, 3] . All adverse side effects are scored on specific international scales according to severity of symptoms or clinical evidence, which may vary from minimal to very serious, and even compromise the patient’s survival. The “radiation therapy oncology group”(RTOG) scale [4] and the “common terminology criteria for adverse events”(CTCAE) system [5] were designed to assess acute and late side effects. The subjective, objective, management, analyt

FAQs

What causes acute and late toxicity in pelvic radiotherapy for gynecological cancers?

Acute and late toxicity arises from irradiation of organs at risk such as small and large bowel, rectum, bladder, pelvic bone, vagina, and bone marrow.

How does the position paper support toxicity prevention and management?

It provides evidence-based strategies to prevent and manage acute and late toxicities, based on literature searches and organized workgroups of radiation oncologists with extensive experience.

Which scoring systems are mentioned for adverse effects severity and timing?

The document cites the RTOG scale and CTCAE for assessing acute and late effects, and the SOMA/LENT scale for late side effects; QoL questionnaires are also used to evaluate symptoms.

Sep 21, 2026

Upload by Levi