Algorithm-based management of patients with gastrointestinal symptoms in patients after pelvic radiation treatment (ORBIT): a randomised controlled trial

Andreyev, H. J. N.; Benton, Barbara; Lalji, Amyn; Norton, Christine; Mohammed, Kabir; Gage, Heather; Pennert, Kjell; Lindsay, James O.

doi:10.1016/s0140-6736(13)61648-7

Cited by 128 publications

(116 citation statements)

References 38 publications

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“…First, there was considerable attrition at 1 y, requiring imputation for ITT analysis. However, the habitualfiber group who reported the worst bowel symptoms in the acute setting also went on to experience the worst symptoms at 1 y postradiotherapy, which fits with previous research (5,22). Second, treatment-related factors were balanced between groups at baseline.…”

Section: Discussionsupporting

confidence: 75%

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Randomized controlled trial of dietary fiber for the prevention of radiation-induced gastrointestinal toxicity during pelvic radiotherapy

Wedlake

Shaw

McNair

et al. 2017

The American Journal of Clinical Nutrition

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Background: Therapeutic radiotherapy is an important treatment of pelvic cancers. Historically, low-fiber diets have been recommended despite a lack of evidence and potentially beneficial mechanisms of fiber.Objective: This randomized controlled trial compared low-, habitual-, and high-fiber diets for the prevention of gastrointestinal toxicity in patients undergoing pelvic radiotherapy. Design: Patients were randomly assigned to low-fiber [#10 g nonstarch polysaccharide (NSP)/d], habitual-fiber (control), or high-fiber ($18 g NSP/d) diets and received individualized counseling at the start of radiotherapy to achieve these targets. The primary endpoint was the difference between groups in the change in the Inflammatory Bowel Disease QuestionnaireBowel Subset (IBDQ-B) score between the starting and nadir (worst) score during treatment. Other measures included macronutrient intake, stool diaries, and fecal short-chain fatty acid concentrations. Results: Patients were randomly assigned to low-fiber (n = 55), habitual-fiber (n = 55), or high-fiber (n = 56) dietary advice. Fiber intakes were significantly different between groups (P , 0.001). The difference between groups in the change in IBDQ-B scores between the start and nadir was not significant (P = 0.093). However, the change in score between the start and end of radiotherapy was smaller in the high-fiber group (mean 6 SD: 23.7 6 12.8) than in the habitual-fiber group (210.8 6 13.5; P = 0.011). At 1-y postradiotherapy (n = 126) the difference in IBDQ-B scores between the high-fiber (+0.1 6 14.5) and the habitualfiber (28.4 6 13.3) groups was significant (P = 0.004). No significant differences were observed in stool frequency or form or in short-chain fatty acid concentrations. Significant reductions in energy, protein, and fat intake occurred in the low-and habitualfiber groups only. Conclusions: Dietary advice to follow a high-fiber diet during pelvic radiotherapy resulted in reduced gastrointestinal toxicity both acutely and at 1 y compared with habitual-fiber intake. Restrictive, non-evidence-based advice to reduce fiber intake in this setting should be abandoned. This trial was registered at clinicaltrials.gov as NCT 01170299.Am J Clin Nutr doi: https://doi.org/10.3945/ajcn.116.150565.

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Section: Discussionsupporting

confidence: 75%

“…Acutely (during treatment), 90% of patients experience changes in bowel habit (4). Delayed intestinal radiation toxicity is a progressive condition with few therapeutic options and substantial long-term morbidity and mortality (5). Currently there are an estimated 1.6 million Americans living with postradiation intestinal dysfunction (1).…”

Section: Introductionmentioning

confidence: 99%

Randomized controlled trial of dietary fiber for the prevention of radiation-induced gastrointestinal toxicity during pelvic radiotherapy

Wedlake

Shaw

McNair

et al. 2017

The American Journal of Clinical Nutrition

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“…At our institution, a gastroenterology-led multidisciplinary clinic offers patients with symptoms arising during/after cancer therapies review, investigation, and treatment using a detailed peer-reviewed algorithm. 1 This approach has identified and characterized a treatable physiological cause for GI toxicity from a chemotherapeutic or biological agent: namely, lenalidomide, a novel treatment of myeloma.…”

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confidence: 99%

Lenalidomide-induced diarrhea in patients with myeloma is caused by bile acid malabsorption that responds to treatment

Pawlyn

Khan

Muls

et al. 2014

Blood

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“…Other diagnoses where excluded or treated by following a management algorithm. 24 Patients were established on medication, if required, prior to the initiation of the dietary intervention. There was no statistically significant change in dietary fibre intake after dietary intervention which could have potentially acted as confounding factors.…”

Section: Discussionmentioning

confidence: 99%

Management of bile acid malabsorption using low-fat dietary interventions: a useful strategy applicable to some patients with diarrhoea-predominant irritable bowel syndrome?

et al. 2015

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Algorithm-based management of patients with gastrointestinal symptoms in patients after pelvic radiation treatment (ORBIT): a randomised controlled trial

Cited by 128 publications

References 38 publications

Randomized controlled trial of dietary fiber for the prevention of radiation-induced gastrointestinal toxicity during pelvic radiotherapy

Randomized controlled trial of dietary fiber for the prevention of radiation-induced gastrointestinal toxicity during pelvic radiotherapy

Lenalidomide-induced diarrhea in patients with myeloma is caused by bile acid malabsorption that responds to treatment

Management of bile acid malabsorption using low-fat dietary interventions: a useful strategy applicable to some patients with diarrhoea-predominant irritable bowel syndrome?

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