Late effects of intraoperative radiation therapy on retroperitoneal tissues, intestine, and bile duct in a large animal model.
OBJECTIVE
The late histopathological effects of intraoperative radiotherapy (IORT) on retroperitoneal tissues, intestine, and bile duct were investigated in dogs.


METHODS
Fourteen adult foxhounds were subjected to laparotomy and varying doses (0-45 Gy) of IORT (11 MeV electrons) delivered to retroperitoneal tissues including the great vessels and ureters, to a loop of defunctionalized small bowel, or to the extrahepatic bile duct. One control animal received an aortic transection and reanastomosis at the time of laparotomy; another control received laparotomy alone. This paper describes the late effects of single-fraction IORT occurring 3-5 years following treatment.


CONCLUSIONS
Dogs receiving IORT to the retroperitoneum through a 4 x 15 cm portal showed few gross or histologic abnormalities at 20 Gy. At doses ranging from 30-45 Gy, radiation changes in normal tissues were consistently observed. Retroperitoneal fibrosis with encasement of the ureters and great vessels developed at doses > or = 30 Gy. Radiation changes were present in the aorta and vena cava at doses > or = 40 Gy. A 30 Gy dog developed an in-field malignant osteosarcoma at 3 years which invaded the vertebral column and compressed the spinal cord. A 40 Gy animal developed obstruction of the right ureter with fatal septic hydronephrosis at 4 years. Animals receiving IORT through a 5 cm IORT portal to an upper abdominal field which included a defunctionalized loop of small bowel, showed a few gross or histologic abnormalities at a dose of 20 Gy. At 30 Gy, hyaline degeneration of the intestinal muscularis layer of the bowel occurred. At a dose of 45 Gy, internal intestinal fistulae developed. One 30 Gy animal developed right ureteral obstruction and hydronephrosis at 5 years. A dog receiving 30 Gy IORT through a 5 cm portal to the extrahepatic bile duct showed diffuse fibrosis through the gastroduodenal ligament. These canine studies contribute to the area of late tissue tolerance to IORT.
Sindelar
W F
WF
Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892.
Tepper
J E
JE
Kinsella
T J
TJ
Barnes
M
M
DeLuca
A M
AM
Terrill
R
R
Matthews
D
D
Anderson
W J
WJ
Bollinger
B K
BK
Johnstone
P A
PA
D000714:Anastomosis, Surgical; D000818:Animals; D001012:Aorta, Abdominal / Q000528:radiation effects / Q000601:surgery; D017734:Bile Ducts, Extrahepatic / Q000528:radiation effects*; D003131:Combined Modality Therapy; D004285:Dogs; D004307:Dose-Response Relationship, Radiation; D007421:Intestine, Small / Q000528:radiation effects*; D007430:Intraoperative Care; D007813:Laparotomy; D008954:Models, Biological; D011833:Radiation Injuries, Experimental / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods*; D012185:Retroperitoneal Fibrosis / Q000209:etiology; D012187:Retroperitoneal Space / Q000528:radiation effects; D014513:Ureter / Q000528:radiation effects*; D014682:Vena Cava, Inferior / Q000528:radiation effects