title: Acute and Late Bowel Toxicity in Radiotherapy Patients with Inflammatory Bowel Disease: A Systematic Review.
abstract: OBJECTIVE
  Inflammatory bowel disease has traditionally been considered a relative contraindication for radiotherapy due to a perceived increased risk of disease exacerbation and bowel toxicity. The aim of this review was to evaluate the current literature regarding rates of radiotherapy-induced acute and late bowel toxicity in patients with inflammatory bowel disease and to compare these data with those of patients without the disease.
  
  
  METHODS
  An Ovid Medline search was conducted to identify original articles pertaining to the review question. Using the PRISMA convention a total of 442 articles screened, resulting 8 articles which were suitable for inclusion in the review.
  
  
  RESULTS
  In general, the grading of toxicity was scored using either the Radiation Therapy Oncology Group or Common Terminology Criteria for Adverse Events scoring systems. It was found that acute bowel toxicity of ≥ grade 3 occurred in 20% of patients receiving external beam radiotherapy (EBRT) and in 7% of patients receiving brachytherapy. Late bowel toxicity ≥ grade 3 occurred in 15% of EBRT patients and in 5% of patients receiving brachytherapy. Brachytherapy was shown to have similar rates of toxicity and EBRT produced a moderate increase in both acute and late toxicity when compared with individuals without inflammatory bowel disease.
  
  
  CONCLUSIONS
  In view of these results, we suggest that brachytherapy should be considered as a suitable treatment option for treating pelvic malignancy in patients with inflammatory bowel disease, whereas EBRT should be used with caution.
authors.affiliation: Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University Gold Coast Campus, Southport, Queensland, Australia. Electronic address: dirktromp@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Tromp
authors.affiliation: Genesis CancerCare Queensland, Tugun, Queensland, Australia; Bond University, Robina, Queensland, Australia.
authors.forename: D R H
authors.initials: DR
authors.lastname: Christie
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases; D007410:Intestinal Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010386:Pelvic Neoplasms / Q000150:complications / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects; D013997:Time Factors; D055815:Young Adult
keywords: Bowel toxicity; brachytherapy; inflammatory bowel disease; radiotherapy