During radiotherapy 80% to 90% of all patients will develop some degree of inflammation symptoms, such as erythema, dry or wet desquamation, skin folds, or mucositis depending on radiation-and patient-related factors and the extent of irradiated skin or mucosal areas. Up to now radiation induced local reactions represent still an important toxicity factor. Cutaneous and mucosal side effects may reduce the patient's compliance and can be limiting factors to follow radiotherapy protocols. Therefore, there is a high need for effective prophylactic and therapeutic treatments. Basically, guidelines recommend the avoidance of mechanical, chemical and thermal irritants, especially the exposure to high temperatures. To delay onset of radiodermatitis various preventive topicals may be applied like aqueous cream formula with or without antioxidative agents. In general, the treatment of radiodermatitis primarily should maintain moisture and skin permeability and consists of hydrophilic creams, antioxidative and anti-inflammatory topicals. Hydrocolloid dressings may reduce and improve wound healing in grade 2 and 3 reactions. Supportive therapy of radiation-induced mucositis includes the maintenance of oral care protocols and adequate nutrition during the course of treatment. A sufficient oral health status is one of the most important factors for prevention of severe oral complications. The MASCC guidelines recommend furthermore the use of non-medicated rinses with saline or sodium bicarbonate 4 to 6 times daily. Further approaches suggest the use of local anaesthetics and systemic analgesics for severe mucositis. Besides local preventive agents and supportive care protocols, modern radiation treatment techniques remain the most promising intervention in reducing the degree of skin reactions.

A multidisciplinary approach integrating surgery, radiotherapy and systemic treatment has gained importance in the treatment of gastrointestinal (GI) cancer. Significant progress in curing localized cancer and prolonging lives in metastatic cancer has been reached. However, side effects, predominantly GI toxicity, are frequent and often dose-limiting. Patients encounter mucosal injuries resulting in oesophagitis, gastritis, nausea and vomiting, colitis causing diarrhoea or constipation. In rarer cases drugs cause hepatotoxicity or pancreatitis. Nausea, vomiting and diarrhoea are the main digestive toxicities in GI cancer patient undergoing chemo- and/or-radiotherapy. Quick relief from these side effects is important to improve the quality of life and also to prevent hospitalization. Professional prophylactic and on demand care to prevent or treat these toxicities are warranted. Supportive care should be tailored to the individual patient and to the underlying pathophysiology. This review focuses on the acute side effects in gastrointestinal cancer treatment and emphasizes therapeutic approaches which could ameliorate severity and incidence of toxicities.

Even in the era of improved surgical resection techniques adjuvant or neoadjuvant radio/-chemotherapy contributes to a better local control. Short-course preoperative radiotherapy or long-term preoperative radiochemotherapy are two different options with proven efficacy. The first approach may be reasonable for patients in whom a complete surgical removal is possible upfront. Preoperative combined radiochemotherapy is certainly more appropriate for patients who need significant downsizing of the tumour to achieve a resection with clear surgical margins. Acute toxicity is more pronounced during combined preoperative treatment, but long-term side-effects may be more prevalent when using short-course radiation. So far the increase in local control following neoadjuvant treatment could not be translated in a substantial survival benefit. Improvements in surgical and radiation techniques as well as a more effective systemic treatment may offer further advantages. However the results of ongoing trials employing newer cytotoxic agents together with neoadjuvant radiation have to be awaited before their use can be advocated routinely. RC is a malignant disease that warrants close multidisciplinary cooperation and each discipline should treat the patients with the highest standard of quality to achieve optimal results.