title: Ileal perforation induced by acute radiation injury under gefitinib treatment.
abstract: Enteritis is one of the side effects of radiotherapy to the abdominal cavity. Radiation enteritis involves damage to mucous membranes in the acute phase and to stromal tissues in the late phase. Perforation of the intestine tends to occur in the late phase, and rarely in the acute phase. However, we describe here a case of intestinal perforation occurring in the acute phase after irradiation in a patient who received gefitinib treatment. Gefitinib, one of the epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), is widely used to treat non-small cell lung cancer (NSCLC) patients, but is simultaneously known to inhibit wound healing. We suspect that gefitinib may affect regeneration of the small intestinal mucosa injured by irradiation. A 76-year-old woman had NSCLC with metastases to the 5th lumbar, sacral, and right iliac bones. To control the pain from bone metastasis, anterior-posterior opposing portal irradiation (total 35 Gy) was started, and was completed over 22 days. On day 25 after starting radiotherapy, the patient began to take gefitinib. On day 35, she presented with acute peritonitis, and an emergency laparotomy was performed. The terminal ileum was affected by radiation enteritis and there were two pin-hole perforations. In the surgical specimen, no cancerous lesions were detected, and immunohistochemical staining of phosphorylated EGFR (pEGFR) was negative. pEGFR has an important role in mucous membrane repair after irradiation. Intestinal perforation in the acute phase of radiation enteritis may be associated with impaired mucosal repair mechanisms due to the use of an EGFR-TKI such as gefitinib, as evidenced by the absence of pEGFR.
authors.affiliation: Department of Cancer and Thoracic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kia-ku, Okayama 700-8558, Japan. gmd18602@cc.okayama-u.ac.jp
authors.forename: Takayuki
authors.initials: T
authors.lastname: Muraoka
authors.forename: Kazunori
authors.initials: K
authors.lastname: Tsukuda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Toyooka
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kagawa
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Naomoto
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Takemoto
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Katsui
authors.forename: Susumu
authors.initials: S
authors.lastname: Kanazawa
authors.forename: Yuho
authors.initials: Y
authors.lastname: Maki
authors.forename: Hiroko
authors.initials: H
authors.lastname: Masuda
authors.forename: Masaaki
authors.initials: M
authors.lastname: Harada
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Asano
authors.forename: Minoru
authors.initials: M
authors.lastname: Naito
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Miyoshi
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000532:radiotherapy; D004751:Enteritis / Q000209:etiology / Q000473:pathology*; D066246:ErbB Receptors / Q000037:antagonists & inhibitors* / Q000378:metabolism; D005260:Female; D000077156:Gefitinib; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects; D007421:Intestine, Small / Q000293:injuries / Q000528:radiation effects; D008175:Lung Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D010538:Peritonitis / Q000139:chemically induced / Q000601:surgery; D011799:Quinazolines / Q000009:adverse effects*; D011832:Radiation Injuries; D011878:Radiotherapy / Q000009:adverse effects; D014945:Wound Healing / Q000187:drug effects
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; C512478:EGFR protein, human; D066246:ErbB Receptors; D000077156:Gefitinib