Steady diet as prophylaxis of acute diarrhea in preoperative pelvic radiotherapy of rectal adenocarcinoma

López, E.; Serrano, C. Bueno; Liñán, M. Rodríguez; Cabezas, S. García; Eito, A. Palacios

doi:10.1016/j.rpor.2013.03.841

Cited by 2 publications

(1 citation statement)

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“…These findings are in keeping with recent research from our group which has shown that an individualised approach to increasing or decreasing fibre intake was of benefit to both groups when compared with ad libitum intake ( 65 ) . Another small comparator study ( n 29) indicated that patients following an ‘exclusion’ as distinct from ‘steady diet’ experienced significantly worse toxicity, weight loss and quality of life ( 84 ) although no details of the intervention are provided. In summary, it seems that an individualised approach, free from restrictive practices with appropriate professional advice (counselling) to manipulate dietary intake based on emerging needs throughout treatment is the way forward.…”

Section: Discussionmentioning

confidence: 99%

Nutritional strategies to prevent gastrointestinal toxicity during pelvic radiotherapy

Wedlake

2018

Proc. Nutr. Soc.

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Radiotherapy-induced damage to non-cancerous gastrointestinal mucosa has effects on secretory and absorptive functions and can interfere with normal gastrointestinal physiology. Nutrient absorption and digestion may be compromised. Dietary manipulation is an attractive option with sound rationale for intervention. The aim of this review was to synthesise published evidence for the use of elemental formulae, low or modified fat diets, fibre, lactose restriction and probiotics, prebiotics and synbiotics to protect the bowel from gastrointestinal side effects during long-course, radical pelvic radiotherapy. Thirty original studies (recruiting n 3197 patients) were identified comprising twenty-four randomised controlled trials, four cohort studies and two comparator trials. Endpoints varied and included symptom scales (Inflammatory Bowel Disease Questionnaire, Common Technology Criteria for Adverse Events, Radiation Therapy Oncology Group) and Bristol Stool Scale. Dietary and supplement interventions were employed with many studies using a combination of interventions. Evidence from RCT was weak for elemental, low or modified fat and low-lactose interventions and modestly positive for the manipulation of fibre during radiotherapy. Evidence for probiotics as prophylactic interventional agents was more promising with a number of trials reporting positive results but strength and strains of interventions vary, as do methodologies and endpoints making it difficult to arrive at firm conclusions with several studies lacking statistical power. This consolidated review concludes that there is insufficient high-grade evidence to recommend nutritional intervention during pelvic radiotherapy. Total replacement of diet with elemental formula could be effective in severe toxicity but this is unproven. Probiotics offer promise but cannot be introduced into clinical practice without rigorous safety analysis, not least in immunocompromised patients.

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Section: Discussionmentioning

confidence: 99%

Nutritional strategies to prevent gastrointestinal toxicity during pelvic radiotherapy

Wedlake

2018

Proc. Nutr. Soc.

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Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers

Lawrie

Green

Beresford

et al. 2018

Cochrane Database of Systematic Reviews

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Conformal radiotherapy techniques are an improvement on older radiotherapy techniques. IMRT may be better than 3DCRT in terms of GI toxicity, but the evidence to support this is uncertain. There is no high-quality evidence to support the use of any other prophylactic intervention evaluated. However, evidence on some potential interventions shows that they probably have no role to play in reducing RT-related GI toxicity. More RCTs are needed for interventions with limited evidence suggesting potential benefits.

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Steady diet as prophylaxis of acute diarrhea in preoperative pelvic radiotherapy of rectal adenocarcinoma

Cited by 2 publications

References 0 publications

Nutritional strategies to prevent gastrointestinal toxicity during pelvic radiotherapy

Nutritional strategies to prevent gastrointestinal toxicity during pelvic radiotherapy

Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers

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