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Radiotherapy toxicity

Nature Reviews Disease Primersvolume 5, Article number: 13 (2019) | Download Citation


Radiotherapy is used in >50% of patients with cancer, both for curative and palliative purposes. Radiotherapy uses ionizing radiation to target and kill tumour tissue, but normal tissue can also be damaged, leading to toxicity. Modern and precise radiotherapy techniques, such as intensity-modulated radiotherapy, may prevent toxicity, but some patients still experience adverse effects. The physiopathology of toxicity is dependent on many parameters, such as the location of irradiation or the functional status of organs at risk. Knowledge of the mechanisms leads to a more rational approach for controlling radiotherapy toxicity, which may result in improved symptom control and quality of life for patients. This improved quality of life is particularly important in paediatric patients, who may live for many years with the long-term effects of radiotherapy. Notably, signs and symptoms occurring after radiotherapy may not be due to the treatment but to an exacerbation of existing conditions or to the development of new diseases. Although differential diagnosis may be difficult, it has important consequences for patients.

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Change history

  • 04 March 2019

    In the version originally published, an incorrect version of Figure 1 was used. This has now been replaced.


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Reviewer information

Nature Reviews Disease Primers thanks Z. Liao, J. Lucas and the other anonymous reviewer(s), for their contribution to the peer review of this work.

Author information


  1. Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht, Netherlands

    • Dirk De Ruysscher
  2. Department of Radiation Oncology, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    • Gabriele Niedermann
  3. German Cancer Consortium (DKTK), partner site Freiburg, and German Cancer Research Centre (DKFZ), Heidelberg, Germany

    • Gabriele Niedermann
  4. The Christie, Department of Radiation Oncology, Division of Cancer Sciences, University of Manchester, Manchester, UK

    • Neil G. Burnet
  5. Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

    • Shankar Siva
    •  & Fiona Hegi-Johnson
  6. Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia

    • Shankar Siva
    •  & Fiona Hegi-Johnson
  7. Department of Clinical Oncology, The University of Hong Kong and The University of Hong Kong–Shenzhen Hospital, Hong Kong, China

    • Anne W. M. Lee
  8. School of Mathematical and Physical Sciences, The University of Newcastle (UON), Newcastle, New South Wales, Australia

    • Fiona Hegi-Johnson


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Introduction (D.D.R.); Epidemiology (D.D.R. and F.H.-J.); Mechanisms/pathophysiology (D.D.R. and G.N.); Diagnosis, screening and prevention (D.D.R. and N.G.B.); Management (D.D.R. and S.S.); Quality of life (D.D.R., A.W.M.L and F.H.); Outlook (D.D.R.); Overview of the Primer (D.D.R.).

Competing interests

D.D.R. has served on advisory boards for AstraZeneca, Bristol-Meyers-Squibb, Celgene, Merck Serono/Pfizer and Genentech and has received research grants from Bristol-Meyers-Squibb and Boehringer Ingelheim. No personal fees were received, only fees to the institution. The remaining authors declare no competing interests.

Corresponding author

Correspondence to Dirk De Ruysscher.

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