Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy

Henson, Caroline C; Burden, Sorrel; Davidson, Susan E; Lal, Simon

doi:10.1002/14651858.cd009896.pub2

Cited by 49 publications

(46 citation statements)

References 41 publications

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“…They found that there had been benefits demonstrated with dietary modification during pelvic radiotherapy. However, they were unable to determine the effect of elemental diet as data were not available [26]. Our data provided evidence to support the beneficial effect of supplements of glutamine in curing radiation enteritis and were consistent with the results of the clinical studies published in China, however, it lost its significance.…”

Section: Discussionsupporting

confidence: 76%

“…In a previously published meta-analysis [26], the authors assessed nutritional interventions for reducing gastrointestinal toxicity in patients undergoing radical pelvic radiotherapy, they referred nutritional support interventions to standard oral nutrition supplements including amino acid-based supplement and those where novel substrates have been added such as glutamine. They found that there had been benefits demonstrated with dietary modification during pelvic radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic role of glutamine in management of radiation enteritis: a meta-analysis of 13 randomized controlled trials

Cao

et al. 2017

Oncotarget

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ObjectiveTo systematically evaluate the clinical efficacy of glutamine in treating radiation enteritis in cancer patients treated with radiotherapy.MethodsElectronic databases including Pubmed, Embase, the Cochrane library, and CNKI were systematically searched, until April 2016. Randomized controlled trials (RCT) of glutamine in the treatment of radiation enteritis in cancer patients were searched, and RevMan 5.3 software was used for Meta-analysis.ResultsA total of 13 RCTs were included, involving 979 patients. The results of meta-analysis showed that the total efficacy of glutamine was higher for patients with radiation enteritis compared with that in control group, however, there was no statistically significant difference(OR = 3.07, 95%CI: 0.79-11.96; P > 0.05). The combined ORs for all 5 grades(from grade 0 to grade 4) of radiation enteritis in patients receiving glutamine were 2.06, 1.35, 0.55, 0.62 and 0.59, respectively(P > 0.05 for all). Glutamine also failed to significantly improve the symptoms of radiation enteritis in terms of tenesmus, abdominal cramping and blood in bowel movement(P > 0.05).ConclusionsImplementation of glutamine fails to improve the severity and symptoms in patients with radiation enteritis.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Therapeutic role of glutamine in management of radiation enteritis: a meta-analysis of 13 randomized controlled trials

Cao

et al. 2017

Oncotarget

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“…Consistently, a recent Cochrane review of the literature has shown that dietary modifications to the type of fat, restrictions to fat and lactose, and supplementation of fiber during pelvic radiotherapy can help decrease the amount of diarrhea [17]. While minimizing fat intake, the type of fat can also help in the management of inflammation, a topic that will be discussed later in this paper.…”

Section: Ibd Intestinal Prd Diet and Malnutritionmentioning

confidence: 90%

Nutrition in Pelvic Radiation Disease and Inflammatory Bowel Disease: Similarities and Differences

DeWitt

Hegazi

2014

BioMed Research International

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Due to the intestinal inflammation, tissue damage, and painful abdominal symptoms restricting dietary intake associated with both diseases, patients with intestinal pelvic radiation disease (PRD) or inflammatory bowel disease (IBD) are at increased risk to develop protein calorie malnutrition and micronutrient deficiencies. In the current paper, we review the nutritional management of both diseases, listing the similar approaches of nutritional management and the nutritional implications of intestinal dysfunction of both diseases. Malnutrition is prevalent in patients with either disease and nutritional risk screening and assessment of nutritional status are required for designing the proper nutritional intervention plan. This plan may include dietary management, oral nutritional supplementation, and enteral and/or parenteral nutrition. In addition to managing malnutrition, nutrients exert immune modulating effects during periods of intestinal inflammation and can play a role in mitigating the risks associated with the disease activity. Consistently, exclusive enteral feeding is recommended for inducing remission in pediatric patients with active Crohn's disease, with less clear guidelines on use in patients with ulcerative colitis. The field of immune modulating nutrition is an evolving science that takes into consideration the specific mechanism of action of nutrients, nutrient-nutrient interaction, and preexisting nutritional status of the patients.

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“…Combinations of altered fat, fiber intake and putting constraints on lactose supplementation were among the proposed dietary modifications [36].…”

Section: Discussionmentioning

confidence: 99%

Risk of selected gastrointestinal toxicities in cancer patients treated with MEK inhibitors: a comparative systematic review and meta-analysis

Abdel‐Rahman

Elhalawani

Ahmed

et al. 2015

Expert Review of Gastroenterology & Hepatology

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We performed a systematic review and meta-analysis of the risk of gastrointestinal (GI) toxicities associated with MEK inhibitors. Eligible studies included randomized Phase II and III trials of cancer patients on the three MEK inhibitors (trametinib, selumetinib and cobimetinib), describing events of stomatitis, diarrhea and vomiting. Our search strategy yielded 250 potentially relevant citations from Pubmed/Medline, Google scholar and CENTRAL Cochrane registry. After exclusion of ineligible studies, a total of 16 clinical trials were considered eligible for the meta-analysis. The relative risks of all-grade stomatitis, diarrhea and vomiting were 2.03 (95% CI 1.41-2.96; p = 0.002), 1.92 (95% CI 1.48-2.50; p < 0.00001) and 1.35 (95% CI 1.06-1.71; p = 0.01). Subgroup analyses according to agent used (trametinib vs Selumetinib), the regimen used (monotherapy vs combination) and the cancer treated (melanoma vs nonmelanoma) did not reveal any significant difference between the subgroups. Our meta-analysis has demonstrated that MEK inhibitor-based treatment is associated with an increased risk of stomatitis, diarrhea and vomiting compared to control. Clinicians should be aware of this risk and perform regular assessment.

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Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy

Cited by 49 publications

References 41 publications

Therapeutic role of glutamine in management of radiation enteritis: a meta-analysis of 13 randomized controlled trials

Therapeutic role of glutamine in management of radiation enteritis: a meta-analysis of 13 randomized controlled trials

Nutrition in Pelvic Radiation Disease and Inflammatory Bowel Disease: Similarities and Differences

Risk of selected gastrointestinal toxicities in cancer patients treated with MEK inhibitors: a comparative systematic review and meta-analysis

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