Pelvic radiation disease

Andreyev, H. J. N.

doi:10.1111/codi.12812

Cited by 13 publications

(7 citation statements)

References 30 publications

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“…Physiological function is impaired at the level of the mucosa but also bowel motility, pelvic floor and sphincter muscle complex may be affected. Additional contributing factors, such as bacterial overgrowth, bile acid malabsorption and lactose intolerance, have been described [22,23]. Research suggests that many patients have highly treatable bowel dysfunctions, if the cause of the dysfunction is correctly diagnosed [24].…”

Section: Discussionmentioning

confidence: 99%

A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial

et al. 2015

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Background: Total mesorectal excision (TME) combined with preoperative short-term radiotherapy (PRT) reduces local recurrence rates in rectal cancer treatment. However, treatment with radiotherapy increased morbidity and did not result in a longer survival. The aim of this analysis is to provide a comprehensive longitudinal overview of the health-related quality of life (HRQL) and symptoms experienced by rectal cancer patients in the Dutch randomized TME trial from baseline until 14 years after treatment. Methods: Rectal cancer patients (n ¼1530) were randomly allocated to PRT (5 Â 5 Gy) followed by TME or to TME alone. At baseline, 3, 6, 12, 18, and 24 months, 5 years and 14 years after treatment HRQL was evaluated in surviving patients (n ¼606, at 14 years after treatment). Results: None of the general symptoms differed significantly between PRT + TME and TME. However, in both treatment arms the general symptoms were increased at the diagnosis of rectal cancer, after surgery and by aging. With PRT + TME bowel symptoms were increased, specifically more fecal incontinence was reported at all time points, resulting in more use of pads for fecal incontinence (PRT + TME vs. TME at 5 years 51.5% vs. 30.5%, respectively, and at 14 years 56.4% vs. 37.1%, respectively).Conclusions: This longitudinal analysis shows that general symptoms in both groups are increased at the diagnosis of rectal cancer, after surgery and by aging, but not by RT. However, irradiated patients reported more bowel dysfunction at all time points.

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Section: Discussionmentioning

confidence: 99%

A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial

et al. 2015

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“…After our study period ended, pelvic radiation disease with symptoms including diarrhoea has gained more focus, and it has now become an integrated part of the workup in our clinic [27,28]. All patients with pelvic irradiation are now offered basic conservative treatment in the nurse‐led clinic as well as gastroenterological evaluation.…”

Section: Discussionmentioning

confidence: 99%

Nurse‐led standardized intervention for low anterior resection syndrome. A population‐based pilot study

et al. 2021

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Aim Our aim was to study the implementation of the low anterior resection syndrome (LARS) score in a clinical setting and to evaluate a nurse‐led standardized intervention for bowel dysfunction following rectal cancer surgery. Method All patients who underwent curatively intended, restorative rectal cancer resection in a single centre between 2012 and 2016 were screened using the LARS score. At clinical follow‐up, patients with major LARS were offered treatment in a nurse‐led clinic. Data were retrospectively collected from patients' electronic medical records. Results In total, 190 out of 286 (66%) patients were screened with the LARS score of whom 89 had major LARS. A total of 86 patients requested treatment for their bowel dysfunction and the majority obtained acceptable function after nurse‐led optimized conservative treatment. Seventeen patients went on to transanal irrigation, and seven patients were treated with biofeedback. Five patients were referred for surgery, three for gastroenterological evaluation. After treatment in the clinic, patients achieved a statistically significant decrease in median LARS score from 37 (interquartile range 34–39) to 31 (interquartile range 23–34) (P < 0.001), and the prevalence of major LARS fell from 95% to 53% (P < 0.001). Conclusion Screening for LARS was not optimal as one‐third of patients were not screened. The majority of patients with major LARS requested treatment for their symptoms and could be successfully treated with standardized interventions managed in a nurse‐led setting.

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“…However, an increasing body of evidence suggests that radiation-induced late toxicity may be, at least in part, reversible (143, 145), and is often manageable with a multidisciplinary team approach (147–149). Since this is a relatively new area of clinical research, carefully defining meaningful endpoints and adopting standardized, reliable and validated instruments to quantify outcomes is critically important.…”

Section: Clinical Trial Design For Mitigators and Treatment Of Rifmentioning

confidence: 99%

Radiation-Induced Fibrosis: Mechanisms and Opportunities to Mitigate. Report of an NCI Workshop, September 19, 2016.

et al. 2017

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A workshop entitled “Radiation-Induced Fibrosis: Mechanisms and Opportunities to Mitigate” (held in Rockville, MD, September 19, 2016) was organized by the Radiation Research Program and Radiation Oncology Branch of the Center for Cancer Research (CCR) of the National Cancer Institute (NCI), to identify critical research areas and directions that will advance the understanding of radiation-induced fibrosis (RIF) and accelerate the development of strategies to mitigate or treat it. Experts in radiation biology, radiation oncology and related fields met to identify and prioritize the key areas for future research and clinical translation. The consensus was that several known and newly identified targets can prevent or mitigate RIF in pre-clinical models. Further, basic and translational research and focused clinical trials are needed to identify optimal agents and strategies for therapeutic use. It was felt that optimally designed preclinical models are needed to better study biomarkers that predict for development of RIF, as well as to understand when effective therapies need to be initiated in relationship to manifestation of injury. Integrating appropriate endpoints and defining efficacy in clinical trials testing treatment of RIF were felt to be critical to demonstrating efficacy. The objective of this meeting report is to (a) highlight the significance of RIF in a global context, (b) summarize recent advances in our understanding of mechanisms of RIF, (c) discuss opportunities for pharmacological mitigation, intervention and modulation of specific molecular pathways, (d) consider the design of optimal clinical trials for mitigation and treatment and (e) outline key regulatory nonprescriptive frameworks for approval.

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Pelvic radiation disease

Cited by 13 publications

References 30 publications

A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial

A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial

Nurse‐led standardized intervention for low anterior resection syndrome. A population‐based pilot study

Radiation-Induced Fibrosis: Mechanisms and Opportunities to Mitigate. Report of an NCI Workshop, September 19, 2016.

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