The Prophylactic Use of Probiotics in the Prevention of Radiation Therapy-Induced Diarrhea

Abstract

Cancer treatment regimens that include radiation therapy (RT) to the abdominal region for cervical, ovarian, prostate, sigmoid, or colorectal cancer potentially disturb the colonization resistance of the indigenous gut flora, causing RT-induced diarrhea, enteritis, and colitis in more than 80% of patients with cancer. One approach for the prevention of RT-induced diarrhea is the use of probiotics. Randomized clinical trials have demonstrated efficacy of probiotic preparations VSL #3 and Lactobacillus casei DN-114 001 in decreasing the incidence and grade of RT-induced diarrhea. Oncology nurses and advanced practice clinicians are in a position to interpret research findings related to RT-induced diarrhea, enteritis, and colitis and to apply evidence-based practice principles in patients with cancer receiving RT to promote positive outcomes.

Probiotics for prevention of radiation-induced diarrhea: A meta-analysis of randomized controlled trials

“…The main limitation of the primary outcome was influenced by various factors, which may affect the robustness of the conclusion and further confuse the clinical practice. Due to the difference of patients, treatment protocols, onset of intake as well as dosage, time, administration route and duration of delivery, species and strains of probiotics, it is difficult to compare our result with other studies [3, 13, 15, 17, 18, 41]. Consequently, based on current evidence, it may be uncertain to give a precise guidance on how to use probiotics to prevent the radiation-induced diarrhea.…”

“…When vascular injury is extensive, it can result in fibrosis, stenosis and reduction of normal intestinal motility,[39],which consequently increases the permeability of the mucosal cells, favoring the transfer of bacteria from the gastrointestinal tract to the mucosa [13,32, 40]. The growth of this bacteria is excessive, and disrupts the hosts’ immune defenses [17, 32, 41]. Subsequently, inflammation further accelerates the radiation response, the up-regulation of CD11/CD18 on leukocytes and NF-κB increase in the expression of endothelial cell adhesion molecules, which results in leukocyte adhesion to the vascular endothelium and subsequent extravasation of inflammatory cells into the inflamed tissue [42].…”

“…The potential associated benefits may list as follows. First, probiotics may alter the composition and metabolic activity of host’s microflora and therefore set a barrier by lowering intestinal pH [2, 32, 41, 57, 58]. Second, probiotics can enhance the mucosal barrier function and prevent bacteria from overgrowth by producing antibacterial substance [36, 59, 60].…”

Mechanisms and therapeutic effectiveness of lactobacilli

“…L. casei and L. bulgaricus) and L. casei DN-114 001 administration decreased the incidence and frequency of radiation therapy-induced diarrhoea. 242 Diarrhoea is also frequent during antibiotic therapy causing gut flora imbalance. 243 244 L. reuteri 10 10-11 CFU/g (1 g) Acute diarrhoea 263 (randomised, placebo-controlled study)…”

A Perspective on the Application of Pro-/Synbiotics in Clinical Practice

“…Absence of a legal definition allows many pro-/synbiotics are sold as dietary supplements on various levels of quality. The cost of these products can be substantial and may not be covered under patients' health care plan (Matarese et al, 2003; Visich, 2010). …”