Late Effects of Pelvic Radiation Therapy in the Female Patient: A Comprehensive Review

Abstract

Abstract Radiation therapy (RT) is a valuable treatment option for gynecologic cancers, but it is also associated with acute and chronic toxicity that can greatly impact a patient’s quality of life. The severity and incidence of these side effects depend on various factors, such as the site, volume of tissue within the radiation field, treatment schedule, total dose, dose per fraction, and type of RT. Gastrointestinal (GI) toxicity is the most common side effect of pelvic radiation and late toxicity can include strictures, lower GI bleeding, and fibrosis. Genitourinary complications may include hemorrhagic cystitis, urethral and ureteral strictures, urge incontinence, fistulas, vaginal stenosis, premature ovarian insufficiency, and secondary malignancies. Outside the visceral tissues, insufficiency fractures, bone marrow suppression, and skin changes are also sporadically seen. Overall, advances in RT techniques and the understanding of patient-related factors influencing toxicity have led to improvements in treatment outcomes and reduced rates of late side effects. Understanding the late side effects associated with pelvic RT is critical for developing strategies to both minimize the risk of long-term complications and improve the quality of life of patients. This review aims to summarize the late side effects associated with RT in the pelvis and the respective interventions that may help treat toxicities.