title: Pelvic radiation disease: Updates on treatment options.
abstract: Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments.
authors.affiliation: Leonardo Frazzoni, Marina La Marca, Franco Bazzoli, Lorenzo Fuccio, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Frazzoni
authors.affiliation: Leonardo Frazzoni, Marina La Marca, Franco Bazzoli, Lorenzo Fuccio, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: La Marca
authors.affiliation: Leonardo Frazzoni, Marina La Marca, Franco Bazzoli, Lorenzo Fuccio, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Guido
authors.affiliation: Leonardo Frazzoni, Marina La Marca, Franco Bazzoli, Lorenzo Fuccio, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Alessio Giuseppe
authors.initials: AG
authors.lastname: Morganti
authors.affiliation: Leonardo Frazzoni, Marina La Marca, Franco Bazzoli, Lorenzo Fuccio, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Bazzoli
authors.affiliation: Leonardo Frazzoni, Marina La Marca, Franco Bazzoli, Lorenzo Fuccio, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fuccio
keywords: Argon plasma coagulation; Formalin; Gastrointestinal toxicity; Hyperbaric oxygen; Metronidazole; Pelvic radiation disease; Probiotics; Radiation-induced proctopathy; Radiotherapy; Sucralfate