Diarrhoea in irradiated patients: A prospective multicentre observational study

Pergolizzi, Stefano; Maranzano, Ernesto; Angelis, Verena De; Lupattelli, Marco; Frata, Paolo; Spagnesi, S.; Frisio, Maria Luisa; Mandoliti, Giovanni; Delia, Pietro; Malinverni, Giuseppe; Trippa, Fabio; Fabbietti, Letizia; Parisi, Salvatore; Vecchi, Pietro De; Sansotta, Giuseppe; Giorgetti, Celestino; Bergami, Tiziano; Orecchia, Roberto; Portaluri, Maurizio; Signor, M.; Pontoriero, Antonio; Santacaterina, Anna; Gennaro, Davide Di

doi:10.1016/j.dld.2013.04.012

Cited by 9 publications

(4 citation statements)

References 20 publications

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“…The most common symptoms of acute and late rectal toxicity were rectal bleeding, proctitis (urgency/tenesmus) and diarrhea respectively, in line with previous publications [22,28]. Our findings confirmed the dose-effect relationship as regards rectal toxicity, demonstrating that combining IMRT and IGRT dramatically decreased the risks of both acute and late rectal toxicity.…”

Section: Discussionsupporting

confidence: 92%

Nomogram to predict rectal toxicity following prostate cancer radiotherapy

et al. 2017

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BackgroundTo identify predictors of acute and late rectal toxicity following prostate cancer radiotherapy (RT), while integrating the potential impact of RT technique, dose escalation, and moderate hypofractionation, thus enabling us to generate a nomogram for individual prediction.MethodsIn total, 972 patients underwent RT for localized prostate cancer, to a total dose of 70 Gy or 80 Gy, using two different fractionations (2 Gy or 2.5 Gy/day), by means of several RT techniques (3D conformal RT [3DCRT], intensity-modulated RT [IMRT], or image-guided RT [IGRT]). Multivariate analyses were performed to identify predictors of acute and late rectal toxicity. A nomogram was generated based on the logistic regression model used to predict the 3-year rectal toxicity risk, with its accuracy assessed by dividing the cohort into training and validation subgroups.ResultsMean follow-up for the entire cohort was 62 months, ranging from 6 to 235. The rate of acute Grade ≥2 rectal toxicity was 22.2%, decreasing when combining IMRT and IGRT, compared to 3DCRT (RR = 0.4, 95%CI: 0.3–0.6, p<0.01). The 5-year Grade ≥2 risks for rectal bleeding, urgency/tenesmus, diarrhea, and fecal incontinence were 9.9%, 4.5%, 2.8%, and 0.4%, respectively. The 3-year Grade ≥2 risk for overall rectal toxicity increased with total dose (p<0.01, RR = 1.1, 95%CI: 1.0–1.1) and dose per fraction (2Gy vs. 2.5Gy) (p = 0.03, RR = 3.3, 95%CI: 1.1–10.0), and decreased when combining IMRT and IGRT (RR = 0.50, 95% CI: 0.3–0.8, p<0.01). Based on these three parameters, a nomogram was generated.ConclusionsDose escalation and moderate hypofractionation increase late rectal toxicity. IMRT combined with IGRT markedly decreases acute and late rectal toxicity. Performing combined IMRT and IGRT can thus be envisaged for dose escalation and moderate hypofractionation. Our nomogram predicts the 3-year rectal toxicity risk by integrating total dose, fraction dose, and RT technique.

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Section: Discussionsupporting

confidence: 92%

Nomogram to predict rectal toxicity following prostate cancer radiotherapy

et al. 2017

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“…Radiation-induced diarrhea is a potentially severe complication in cancer patients submitted to radiotherapy both alone and concurrent with chemotherapy; it is also the major form of acute toxicity in patients submitted to pelvic irradiation. This is well-known by radiation oncologists (20,21) and it has been reported that patients with comorbidities, especially diabetes, have an increased risk of GI toxicity after pelvic radiation therapy (22,23). We did not observe severe acute GI toxicities in our elderly and frail patients; the use of dietary measures with early intervention to prevent acute toxicity during treatment (24,25) and the involved field 3Dconformal technique using intestinal loops dose constraints (26) could reduce the incidence of intestinal toxicity.…”

Section: Discussionsupporting

confidence: 50%

Very Elderly (>80 Years), Frail Patients with Muscle-invasive Bladder Cancer and Comorbidities: Is Curative Irradiation Feasible?

Santacaterina

Platania

Palazzolo

et al. 2015

Tumori

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“…As exemplified by the assessment scales of the leading European and American scientific societies, the most common symptoms experienced by patients with RP are tenesmus, mucorrhea, pain and bleeding that, from the acute phase, can end in the chronic phase, when fecal incontinence, necrosis and fistula formation could arise (1)(2)(3)(4)(5). Nakamura et al (6) clearly summarized which factors are associated with proctitis, stating the total radiation dose, fractionation regimens, dose parameters of the critical organs, beam delivery techniques and treatment plan quality as crucial for perception of post-radiation quality of life among prostate cancer patients.…”

Section: Literature Overviewmentioning

confidence: 99%

A Ten-year-long Update on Radiation Proctitis Among Prostate Cancer Patients Treated With Curative External Beam Radiotherapy

Ferini¹,

Pergolizzi

2021

In Vivo

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This comprehensive synopsis summarizes the most relevant information obtained from a systematic analysis of studies of the last decade on radiation proctitis, one of the most feared radioinduced side effects among prostate cancer patients treated with curative external beam radiotherapy. The present review provides a useful support to radiation oncologists for limiting the onset or improving the treatment of radiation proctitis. This work shows that the past decade was a harbinger of significant new evidence in technological advances and technical tricks to avoid radiation proctitis, in addition to dosimetric perspectives and goals, understanding of pathogenesis, diagnostic work-up and treatment. We believe that a well-rounded knowledge of such an issue is fundamental for its appropriate management.

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Diarrhoea in irradiated patients: A prospective multicentre observational study

Cited by 9 publications

References 20 publications

Nomogram to predict rectal toxicity following prostate cancer radiotherapy

Nomogram to predict rectal toxicity following prostate cancer radiotherapy

Very Elderly (>80 Years), Frail Patients with Muscle-invasive Bladder Cancer and Comorbidities: Is Curative Irradiation Feasible?

A Ten-year-long Update on Radiation Proctitis Among Prostate Cancer Patients Treated With Curative External Beam Radiotherapy

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