title: Prevention and Management of Radiation-induced Late Gastrointestinal Toxicity.
abstract: In the UK, about 90,000 cancer survivors will suffer from pelvic radiation disease (PRD) due to their curative treatment including radiotherapy. The National Cancer Survivorship Initiative aims to improve the understanding and management of PRD by the oncology community. This overview covers the prevention, investigation and treatment for late radiation-induced gastrointestinal symptoms in PRD. Multiple pharmacological and nutritional interventions have been studied, as prophylaxis for acute gastrointestinal toxicity (aiming to prevent late consequential effects), although predominantly only small randomised controlled trials have been conducted. These have produced mixed results, although promising signals for some agents have been observed. Evidence for the pharmacological prevention of late gastrointestinal toxicity is scarce. Even fewer randomised controlled trials have investigated the late gastrointestinal toxicity profile of advanced radiotherapy technologies. There are nationally agreed algorithms for the investigation and management of PRD, but a lack of awareness means patients still do not get referred appropriately. This overview outlines the management of radiation proctopathy and diarrhoea, and signposts other accessible resources. Finally, we provide recommendations for the management of late gastrointestinal symptoms in PRD and research in this field, especially the need for high-quality clinical trials.
authors.affiliation: Radiotherapy Research Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK; St James Institute of Oncology, St James University Hospital, Leeds, UK. Electronic address: m.t.w.teo@leeds.ac.uk.
authors.forename: M T W
authors.initials: MT
authors.lastname: Teo
authors.affiliation: Radiotherapy Research Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK; St James Institute of Oncology, St James University Hospital, Leeds, UK.
authors.forename: D
authors.initials: D
authors.lastname: Sebag-Montefiore
authors.affiliation: Leeds Gastroenterology Institute, St James University Hospital, Leeds, UK.
authors.forename: C F
authors.initials: CF
authors.lastname: Donnellan
mesh_terms: D019468:Disease Management; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000517:prevention & control*; D041981:Gastrointestinal Tract / Q000528:radiation effects*; D006801:Humans; D008297:Male; D010386:Pelvic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011878:Radiotherapy / Q000009:adverse effects*; D017741:Survivors
keywords: Bowel toxicity; cancer; management; pelvic radiation disease; prevention; radiotherapy; review