“…Four trials evaluated the effect of oral TCM [ 12 , 26 – 28 ], 3 trials focused on the oral application of sucralfate [ 23 – 25 ] and a trial tested retinyl palmitate in radiation-induced intestinal inflammation [ 17 ]. Other studies on the application pentoxifylline [ 29 ], butyrate [ 19 ] and high-fibre diet [ 30 ] were also documented. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Amoung these trails, some studies on Gynecological tumors included female specifically [ 27 , 31 ], while some focus on prostate cancers which only occurs in male [ 25 ]. Four studies did not point out specific original cancer site [ 12 , 17 , 19 , 29 ]. Detailed information of included studies and corresponding risk of bias was listed in Supplementary Table series S 1 .…”
Section: Resultsmentioning
confidence: 99%
“…Most of the trials made use of comprehensive scoring system for evaluation and data presentation, such as RTOG/EORTC toxicity grades [ 25 , 27 , 29 ], KPS score [ 27 , 31 ] and Vienna rectoscopic score [ 27 ]. Some studies applied self-developed scaling systems [ 17 , 19 , 24 , 31 ]. These scaling systems commonly involve diarrhoea frequency, bleeding, pain and surgery possibility.…”
Section: Resultsmentioning
confidence: 99%
“…We classified the application of retinyl palmitate [ 17 ], butyrate [ 19 ] and high-fibre diet (HFD, [ 30 ]) as supplements and compared their effect on radiation proctitis using meta-analysis. Ehrenpreis and Wang’s studies are heterogeneity, and we used random effect model instead for evaluation (Tau 2 = 6.34; χ 2 = 2.89, df = 1, P = 0.09; I 2 = 65%).…”
Section: Resultsmentioning
confidence: 99%
“…The combination of vitamins C and E, as antioxidants, reduces bleeding, diarrhoea and urgency [ 18 ]. Pentoxifylline, a phosphodiesterase inhibitor, serves as immunomodulator that down-regulates cytokines as well as a fibrogenic reaction mediator after irradiation which eases radiation-induced inflammatory and fibrotic process [ 19 ].…”
Background
Chronic radiation proctitis (CRP) is a long-term complication of pelvic radiotherapy that manifests as rectal bleeding, diarrhoea, fistula formation and obstruction. Treatments such as endoscopic argon plasma coagulation, hyperbaric oxygen therapy and rectal topical formalin have imposed a significant medical burden on CRP patients. In contrast, oral therapies offer a more accessible and acceptable option for managing CRP. Here, we conducted a systematic review of the efficacy of oral treatments for CRP to assess their potential as an effective and convenient treatment option for this condition.
Methods
We searched the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, China National Knowledge Infrastructure and Chinese VIP in February 2021. We included post-radiotherapy participants with CRP that compared oral medicine alone or in combination with other treatments versus control treatments. The primary outcomes were bleeding, diarrhoea and symptom score. Heterogeneity between studies was checked using Cochrane Q test statistics and I2 test statistics. The Cochrane risk-of-bias tool was used to assess the quality of the included studies.
Results
We included 10 randomised controlled trials (RCTs) and 1 retrospective study with 898 participants. Three placebo-controlled trials evaluated the effects of oral sucralfate on CRP, with meta-analysis showing no significant different with placebo arm. Four trials on TCM demonstrated significant improvement of symptoms, especially for the 3 trials on oral TCM drinks. Retinyl palmitate and high-fibre diet were found to reduce rectal bleeding. The combination of oral pentoxifylline and tocopherol did not significantly change the process of CRP.
Conclusions
Our study implies that oral TCM drinks, retinyl palmitate and a high-fiber diet showed significant improvement in CRP symptoms, but not with the combination of oral pentoxifylline and tocopherol. Further multicentre, larger-scale RCTs are needed to confirm the efficacy and safety of these treatments and optimize treatment strategies, ultimately improving the quality of life for patients with CRP.
“…Four trials evaluated the effect of oral TCM [ 12 , 26 – 28 ], 3 trials focused on the oral application of sucralfate [ 23 – 25 ] and a trial tested retinyl palmitate in radiation-induced intestinal inflammation [ 17 ]. Other studies on the application pentoxifylline [ 29 ], butyrate [ 19 ] and high-fibre diet [ 30 ] were also documented. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Amoung these trails, some studies on Gynecological tumors included female specifically [ 27 , 31 ], while some focus on prostate cancers which only occurs in male [ 25 ]. Four studies did not point out specific original cancer site [ 12 , 17 , 19 , 29 ]. Detailed information of included studies and corresponding risk of bias was listed in Supplementary Table series S 1 .…”
Section: Resultsmentioning
confidence: 99%
“…Most of the trials made use of comprehensive scoring system for evaluation and data presentation, such as RTOG/EORTC toxicity grades [ 25 , 27 , 29 ], KPS score [ 27 , 31 ] and Vienna rectoscopic score [ 27 ]. Some studies applied self-developed scaling systems [ 17 , 19 , 24 , 31 ]. These scaling systems commonly involve diarrhoea frequency, bleeding, pain and surgery possibility.…”
Section: Resultsmentioning
confidence: 99%
“…We classified the application of retinyl palmitate [ 17 ], butyrate [ 19 ] and high-fibre diet (HFD, [ 30 ]) as supplements and compared their effect on radiation proctitis using meta-analysis. Ehrenpreis and Wang’s studies are heterogeneity, and we used random effect model instead for evaluation (Tau 2 = 6.34; χ 2 = 2.89, df = 1, P = 0.09; I 2 = 65%).…”
Section: Resultsmentioning
confidence: 99%
“…The combination of vitamins C and E, as antioxidants, reduces bleeding, diarrhoea and urgency [ 18 ]. Pentoxifylline, a phosphodiesterase inhibitor, serves as immunomodulator that down-regulates cytokines as well as a fibrogenic reaction mediator after irradiation which eases radiation-induced inflammatory and fibrotic process [ 19 ].…”
Background
Chronic radiation proctitis (CRP) is a long-term complication of pelvic radiotherapy that manifests as rectal bleeding, diarrhoea, fistula formation and obstruction. Treatments such as endoscopic argon plasma coagulation, hyperbaric oxygen therapy and rectal topical formalin have imposed a significant medical burden on CRP patients. In contrast, oral therapies offer a more accessible and acceptable option for managing CRP. Here, we conducted a systematic review of the efficacy of oral treatments for CRP to assess their potential as an effective and convenient treatment option for this condition.
Methods
We searched the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, China National Knowledge Infrastructure and Chinese VIP in February 2021. We included post-radiotherapy participants with CRP that compared oral medicine alone or in combination with other treatments versus control treatments. The primary outcomes were bleeding, diarrhoea and symptom score. Heterogeneity between studies was checked using Cochrane Q test statistics and I2 test statistics. The Cochrane risk-of-bias tool was used to assess the quality of the included studies.
Results
We included 10 randomised controlled trials (RCTs) and 1 retrospective study with 898 participants. Three placebo-controlled trials evaluated the effects of oral sucralfate on CRP, with meta-analysis showing no significant different with placebo arm. Four trials on TCM demonstrated significant improvement of symptoms, especially for the 3 trials on oral TCM drinks. Retinyl palmitate and high-fibre diet were found to reduce rectal bleeding. The combination of oral pentoxifylline and tocopherol did not significantly change the process of CRP.
Conclusions
Our study implies that oral TCM drinks, retinyl palmitate and a high-fiber diet showed significant improvement in CRP symptoms, but not with the combination of oral pentoxifylline and tocopherol. Further multicentre, larger-scale RCTs are needed to confirm the efficacy and safety of these treatments and optimize treatment strategies, ultimately improving the quality of life for patients with CRP.
Radiotherapy is a widely used cancer treatment that utilizes powerful radiation to destroy cancer cells and shrink tumors. While radiation can be beneficial, it can also harm the healthy tissues surrounding the tumor. Recent research indicates that the microbiota, the collection of microorganisms in our body, may play a role in influencing the effectiveness and side effects of radiation therapy. Studies have shown that specific species of bacteria living in the stomach can influence the immune system’s response to radiation, potentially increasing the effectiveness of treatment. Additionally, the microbiota may contribute to adverse effects like radiation-induced diarrhea. A potential strategy to enhance radiotherapy outcomes and capitalize on the microbiome involves using probiotics. Probiotics are living microorganisms that offer health benefits when consumed in sufficient quantities. Several studies have indicated that probiotics have the potential to alter the composition of the gut microbiota, resulting in an enhanced immune response to radiation therapy and consequently improving the efficacy of the treatment. It is important to note that radiation can disrupt the natural balance of gut bacteria, resulting in increased intestinal permeability and inflammatory conditions. These disruptions can lead to adverse effects such as diarrhea and damage to the intestinal lining. The emerging field of radiotherapy microbiome research offers a promising avenue for optimizing cancer treatment outcomes. This paper aims to provide an overview of the human microbiome and its role in augmenting radiation effectiveness while minimizing damage.
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