Prevention and Management of Radiation-induced Late Gastrointestinal Toxicity》.pdfVIP

Clinical Oncology 27 (2015) 656e667 Contents lists available at ScienceDirect Clinical Oncology journal homepage: Overview Prevention and Management of Radiation-induced Late Gastrointestinal Toxicity M.T.W. Teo *y, D. Sebag-Montefiore *y, C.F. Donnellan z * Radiotherapy Research Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK y St James Institute of Oncology, St James University Hospital, Leeds, UK z Leeds Gastroenterology Institute, St James University Hospital, Leeds, UK Received 2 May 2015; received in revised form 26 May 2015; accepted 9 June 2015 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 appro