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

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.