Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers

Lawrie, Theresa A; Green, John T.; Beresford, Mark; Wedlake, Linda; Burden, Sorrel; Davidson, Susan E; Lal, Simon; Henson, Caroline C; Andreyev, H. J. N.

doi:10.1002/14651858.cd012529.pub2

Cited by 80 publications

(90 citation statements)

References 227 publications

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“…Radiotherapy (RT) is a well-established treatment option for patients with intermediate or high-risk prostate cancer. Despite technical advances in delivery, pelvic RT exposes parts of the bowel to some degree of radiation, and 90% of patients experience a change in bowel habits during treatment [1][2][3]. Acute symptoms such as diarrhoea, abdominal pain and urgency can occur during the treatment period and may subside after RT completion [1,4].…”

Section: Introductionmentioning

confidence: 99%

“…Nutrition interventions (NI) in cancer care can comprise approaches such as dietary counselling and dietary modification [9,10]. Previous studies have evaluated NI such as elemental diet, fibre supplementation, lactose restriction and modification of fat and fibre intake, in order to reduce bowel symptoms from pelvic RT [2,9,[11][12][13]. Dietary fibres can be differentiated into insoluble fibres which increases stool bulk and have a laxative effect, and soluble fibres which are fermented to a higher degree and enhances short-chain fatty acid (SCFA) production [14], which could potentially reduce inflammatory processes [15,16].…”

Section: Introductionmentioning

confidence: 99%

“…A variety of advices on a modified fibre or lactose intake are provided in the clinic to patients undergoing pelvic RT, which reflects the lack of consensus in this area [18]. Previous NI have shown some benefits in reducing bowel symptoms from pelvic RT, but there is still not enough evidence, and there is a need for high-quality studies with long-term follow-up [2,9,12,13].…”

Section: Introductionmentioning

confidence: 99%

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Effects of a nutrition intervention on acute and late bowel symptoms and health-related quality of life up to 24 months post radiotherapy in patients with prostate cancer: a multicentre randomised controlled trial

Forslund

Ottenblad

Ginman

et al. 2019

Support Care Cancer

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Purpose Radiotherapy to the prostate gland and pelvic lymph nodes may cause acute and late bowel symptoms and diminish quality of life. The aim was to study the effects of a nutrition intervention on bowel symptoms and health-related quality of life, compared with standard care. Methods Patients were randomised to a nutrition intervention (n = 92) aiming to replace insoluble fibres with soluble and reduce intake of lactose, or a standard care group (n = 88) who were recommended to maintain their habitual diet. Bowel symptoms, health-related quality of life and intake of fibre and lactose-containing foods were assessed up to 24 months after radiotherapy completion. Multiple linear regression was used to analyse the effects of the nutrition intervention on bowel symptoms during the acute (up to 2 months post radiotherapy) and the late (7 to 24 months post radiotherapy) phase. Results Most symptoms and functioning worsened during the acute phase, and improved during the late phase in both the intervention and standard care groups. The nutrition intervention was associated with less blood in stools (p = 0.047), flatulence (p = 0.014) and increased loss of appetite (p = 0.018) during the acute phase, and more bloated abdomen in the late phase (p = 0.029). However, these associations were clinically trivial or small. Conclusions The effect of the nutrition intervention related to dietary fibre and lactose on bowel symptoms from pelvic RT was small and inconclusive, although some minor and transient improvements were observed. The results do not support routine nutrition intervention of this type to reduce adverse effects from pelvic radiotherapy.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of a nutrition intervention on acute and late bowel symptoms and health-related quality of life up to 24 months post radiotherapy in patients with prostate cancer: a multicentre randomised controlled trial

Forslund

Ottenblad

Ginman

et al. 2019

Support Care Cancer

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“…This is an important endpoint and may re ect advances in the radiation therapy techniques resulting in more tolerable treatments. IMRT and 3DCRT decrease the rates of gastrointestinal toxicity (11) and IMRT is associated with lower deterioration of health-related QoL (12).…”

Section: Discussionmentioning

confidence: 99%

Assessment of Quality of Life Related to Radiation Proctitis in Patients Who Received Pelvic Radiotherapy

Seabra¹,

Jesus²,

Leão³

et al. 2020

Preprint

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Background: Radiotherapy is widely used in the treatment of several pelvic neoplasms, Radiation-related adverse events may result in intestinal, urinary, sexual, bone and dermatological disorders, impacting quality of life. The prevalence of radiation proctitis is probably underestimated. The aim of this study is to assess the quality of life associated with radiation proctitis in patients undergoing pelvic radiotherapy.Methods: A cohort of 40 consecutive patients from an academic institution in Brazil who received pelvic radiotherapy was analyzed. Patients completed questionnaires EORTC QLQ-C30 and EORTC QLQ-PRT20 at the beginning and at the end of treatment. Clinico-pathological features were also collected using standard templates. Results: Thirty-seven patients were included in the analysis. Thirty-two patients (80%) were male and had prostate cancer. Pelvic radiotherapy was associated with worsening bowel control (p=0.0171) leakage (p=0.0542) and pain (p=0.0074) in EORTC QLQ-PRT20. Patients had increased number of bowel movements per day after treatment (p=0.0036). Fatigue (p=0.0176) and diarrhea (p=0.0103) increased after radiation therapy. There was no statistical difference in global quality of life in patients who received radiotherapy. Conclusion: EORTC QLQ-PRT20 questionnaire is suitable for assessing the quality of life related to radiation proctitis in patients undergoing pelvic radiotherapy. This tool may help clinicians in the management and monitoring of treatment-related adverse events of this treatment modality.

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“…The management of gastrointestinal toxicity is a crucial part of clinical practice (Nicholas et al, ; Serrano, Kalman, & Anscher, ). Currently, there is no strong evidence to support the use of prophylactic or therapeutic agents to reduce RT‐induced gastrointestinal toxicity (Lawrie et al, ).…”

Section: Introductionmentioning

confidence: 99%

Randomized, double‐blind, placebo‐controlled phase II trial of nanocurcumin in prostate cancer patients undergoing radiotherapy

Saadipoor

Razzaghdoust

Simforoosh

et al. 2018

Phytotherapy Research

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Clinical potential of curcumin in radiotherapy (RT) setting is outstanding and of high interest. The main purpose of this randomized controlled trial (RCT) was to assess the beneficial role of nanocurcumin to prevent and/or mitigate radiation-induced proctitis in prostate cancer patients undergoing RT. In this parallel-group study, 64 eligible patients with prostate cancer were randomized to receive either oral nanocurcumin (120 mg/day) or placebo 3 days before and during the RT course.Acute toxicities including proctitis and cystitis were assessed weekly during the treatment and once thereafter using CTCAE v.4.03 grading criteria. Baseline-adjusted hematologic nadirs were also analyzed and compared between the two groups. The patients undergoing definitive RT were followed to evaluate the tumor response.Nanocurcumin was well tolerated. Radiation-induced proctitis was noted in 18/31 (58.1%) of the placebo-treated patients versus 15/33 (45.5%) of nanocurcumintreated patients (p = 0.313). No significant difference was also found between the two groups with regard to radiation-induced cystitis, duration of radiation toxicities, hematologic nadirs, and tumor response. In conclusion, this RCT was underpowered to indicate the efficacy of nanocurcumin in this clinical setting but could provide a considerable new translational insight to bridge the gap between the laboratory and clinical practice.

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Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers

Cited by 80 publications

References 227 publications

Effects of a nutrition intervention on acute and late bowel symptoms and health-related quality of life up to 24 months post radiotherapy in patients with prostate cancer: a multicentre randomised controlled trial

Effects of a nutrition intervention on acute and late bowel symptoms and health-related quality of life up to 24 months post radiotherapy in patients with prostate cancer: a multicentre randomised controlled trial

Assessment of Quality of Life Related to Radiation Proctitis in Patients Who Received Pelvic Radiotherapy

Randomized, double‐blind, placebo‐controlled phase II trial of nanocurcumin in prostate cancer patients undergoing radiotherapy

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