# Mechanistic pathways predictive modeling and translational interventions for radiation enteritis in cervical cancer radiotherapy

## TL;DR

This review explores how to predict and manage radiation enteritis in cervical cancer patients using biological mechanisms and personalized strategies.

## Contribution

The paper integrates mechanistic pathways with predictive modeling and translational interventions for individualized prevention of radiation enteritis.

## Key findings

- Radiation enteritis involves DNA damage, oxidative stress, immune issues, and microbiota changes.
- Predictive models using clinical and radiomic data can help stratify individual risk.
- Therapeutic strategies like antioxidants and microbiota engineering show clinical potential.

## Abstract

Radiation enteritis remains a major dose-limiting toxicity in cervical cancer radiotherapy, significantly impairing treatment continuity, long-term gastrointestinal function, and patient quality of life. Despite advances in radiation techniques, the biological heterogeneity of intestinal radiosensitivity continues to challenge effective prevention and management. This review synthesizes current evidence on the core mechanistic axes underlying radiation enteritis, with a focus on DNA damage response failure, oxidative stress amplification, immune dysregulation, and microbiota disruption. We further summarize emerging predictive frameworks integrating clinical variables, dosimetric parameters, radiomics, and circulating biomarkers to enable individualized risk stratification. Particular attention is given to translational therapeutic strategies, including antioxidant pathway modulation, inflammasome targeting, microbiota engineering, and tissue-protective agents, highlighting both their mechanistic rationale and clinical feasibility. By linking molecular pathophysiology with predictive modeling and intervention development, this review provides an integrated roadmap for precision prevention and management of radiation enteritis in cervical cancer radiotherapy. Such a framework may facilitate risk-adapted treatment planning, mitigate gastrointestinal toxicity, and ultimately improve therapeutic outcomes.

Diagram illustrating precision prevention and management of radiation enteritis in cervical cancer radiotherapy. Sections A to D cover clinical scenarios, core mechanisms of DNA damage, oxidative stress, immune dysregulation, and microbiota disruption, alongside translational interventions. Predictive frameworks include clinical variables, dosimetry, radiomics, and biomarkers, leading to individualized risk stratification and risk-adapted planning to reduce gastrointestinal toxicity and improve outcomes.