[Prevention strategies for radiation-induced rectal injury following pelvic radiotherapy].

Radiation-induced rectal injury is one of the most common complications of pelvic radiotherapy. Once chronic injury develops, it is difficult to treat and often responds poorly to therapy; therefore, prevention should be prioritized. The central preventive strategy is to reduce the radiation dose and irradiated volume of the rectum while increasing the dose gradient between the target and normal tissues. This can be achieved primarily through radiotherapy techniques and pharmacological interventions. Regarding radiotherapy techniques, external-beam radiotherapy has evolved from two-dimensional radiotherapy to three-dimensional conformal radiotherapy and subsequently to image-guided intensity-modulated radiotherapy. Online adaptive radiotherapy can further reduce the margin beyond the planned target volume. Intracavitary brachytherapy has progressed from conventional two-dimensional point-A-based planning to image-guided three-dimensional brachytherapy, with strict rectal dose constraints. Rectal spacer gels directly reduce rectal exposure through physical separation. These technical approaches have relatively strong supporting evidence for reducing rectal toxicity and currently represent the most definitive and effective means of preventing radiation-induced rectal injury. Evidence for pharmacological prevention remains insufficient for mucosal-protective and anti-inflammatory agents. Antioxidants, such as recombinant human superoxide dismutase, have shown some potential, whereas emerging strategies involving probiotics and leukotriene receptor antagonists require further validation. Overall, the evidence for pharmacological interventions is weaker than that for technical protection, and these agents should be considered complementary measures after adequate implementation of radiotherapy-based protection. Regardless of whether technical or pharmacological approaches are used, their effectiveness depends heavily on standardized target delineation, dose constraints, and comprehensive quality control throughout the treatment process. This review summarizes prevention strategies for radiation-induced rectal injury, focusing primarily on cervical cancer radiotherapy and incorporating evidence from clinical practice.