title: Gastrointestinal Toxicities With Combined Antiangiogenic and Stereotactic Body Radiation Therapy.
abstract: Combining the latest targeted biologic agents with the most advanced radiation technologies has been an exciting development in the treatment of cancer patients. Stereotactic body radiation therapy (SBRT) is an ablative radiation approach that has become established for the treatment of a variety of malignancies, and it has been increasingly used in combination with biologic agents, including those targeting angiogenesis-specific pathways. Multiple reports have emerged describing unanticipated toxicities arising from the combination of SBRT and angiogenesis-targeting agents, particularly of late luminal gastrointestinal toxicities. In this review, we summarize the literature describing these toxicities, explore the biological mechanism of action of toxicity with the combined use of antiangiogenic therapies, and discuss areas of future research, so that this combination of treatment modalities can continue to be used in broader clinical contexts.
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
authors.forename: Erqi L
authors.initials: EL
authors.lastname: Pollom
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
authors.forename: Lei
authors.initials: L
authors.lastname: Deng
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Reetesh K
authors.initials: RK
authors.lastname: Pai
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
authors.forename: J Martin
authors.initials: JM
authors.lastname: Brown
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
authors.forename: Amato
authors.initials: A
authors.lastname: Giaccia
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
authors.forename: Billy W
authors.initials: BW
authors.lastname: Loo
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
authors.forename: David B
authors.initials: DB
authors.lastname: Shultz
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
authors.forename: Quynh Thu
authors.initials: QT
authors.lastname: Le
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
authors.forename: Albert C
authors.initials: AC
authors.lastname: Koong
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California. Electronic address: dtchang@stanford.edu.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Chang
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D000068258:Bevacizumab; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D041981:Gastrointestinal Tract / Q000187:drug effects* / Q000528:radiation effects*; D006801:Humans; D007421:Intestine, Small / Q000187:drug effects / Q000528:radiation effects; D009369:Neoplasms / Q000628:therapy*; D009389:Neovascularization, Pathologic / Q000188:drug therapy; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives; D058958:Organs at Risk; D010671:Phenylurea Compounds / Q000009:adverse effects; D016634:Radiosurgery / Q000009:adverse effects*; D000077157:Sorafenib; D013997:Time Factors; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D010671:Phenylurea Compounds; D042461:Vascular Endothelial Growth Factor A; D009536:Niacinamide; D000068258:Bevacizumab; D000077157:Sorafenib