Adverse Events

Tissue atrophy and fibrosis after radiotherapy are predominantly secondary responses to radiation-induced vascular injury.6'7 Fibrosis is a pathological term describing increased interstitial collagen density. It explains tissue hardness (induration) and contraction after high-dose radio-therapy. The histological features of radiation fibrosis include zones of dense, irregular collagen fibers encasing and compressing adjacent structures.8 Fibrosis is a prominent component of late radiotherapy change in many tissues, including skin, subcutaneous tissue, lung, muscle, heart, blood vessels, gastrointestinal tract, and urogenital system.9 Tissue compliance and extensibility are reduced by a change in the proportion and organization of different collagen subtypes.10 Fibrosis contributes to dose-limiting complications through tissue stiffness and contraction and is progressive with time. Stiffness reduces the compliance of organs with important elastic properties, including the lung, heart, and bladder.1113 Contraction of fibrous tissue causes strictures in hollow viscera such as the gastrointestinal tract and ureter, precipitating obstructive complications.

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