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Bolduc DL, Cary LH, Kiang JG, Kurada L, Kumar VP, Edma SA, Olson MG, Vergara VB, Bistline DD, Reese M, Kenchegowda D, Hood M, Korotcov A, Jaiswal S, Blakely WF. Natural-history Characterization of a Murine Partial-body Irradiation Model System: Establishment of a Multiple-Parameter Based GI-ARS Severity-Scoring System. Radiat Res 2024; 201:406-417. [PMID: 38319684 DOI: 10.1667/rade-23-00132.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/15/2023] [Indexed: 02/07/2024]
Abstract
The purpose of this investigation was to characterize the natural history of a murine total-abdominal-irradiation exposure model to measure gastrointestinal acute radiation injury. Male CD2F1 mice at 12 to 15 weeks old received total-abdominal irradiation using 4-MV linear accelerator X-rays doses of 0, 11, 13.5, 15, 15.75 and 16.5 Gy (2.75 Gy/min). Daily cage-side (i.e., in the animal housing room) observations of clinical signs and symptoms including body weights on all animals were measured up to 10 days after exposure. Jejunum tissues from cohorts of mice were collected at 1, 3, 7 and 10 days after exposure and radiation injury was assessed by histopathological analyses. Results showed time- and dose-dependent loss of body weight [for example at 7 days: 0.66 (±0.80) % loss for 0 Gy, 6.40 (±0.76) % loss at 11 Gy, 9.43 (±2.06) % loss at 13.5 Gy, 23.53 (± 1.91) % loss at 15 Gy, 29.97 (±1.16) % loss at 15.75 Gy, and 31.79 (±0.76) % loss at 16.5 Gy]. Negligible clinical signs and symptoms, except body weight changes, of radiation injury were observed up to 10 days after irradiation with doses of 11 to 15 Gy. Progressive increases in the severity of clinical signs and symptoms were found after irradiation with doses >15 Gy. Jejunum histology showed a progressive dose-dependent increase in injury. For example, at 7 days postirradiation, the percent of crypts, compared to controls, decreased to 82.3 (±9.5), 69.2 (±12.3), 45.4 (±11.9), 18.0 (±3.4), and 11.5 (± 1.8) with increases in doses from 11 to 16.5 Gy. A mucosal injury scoring system was used that mainly focused on changes in villus morphology damage (i.e., subepithelial spaces near the tips of the villi with capillary congestion, significant epithelial lifting along the length of the villi with a few denuded villus tips). Peak levels of total-abdominal irradiation induced effects on the mucosal injury score were seen 7 days after irradiation for doses ≥15 Gy, with a trend to show a decline after 7 days. A murine multiple-parameter gastrointestinal acute-radiation syndrome severity-scoring system was established based on clinical signs and symptoms that included measures of appearance (i.e., hunched and/or fluffed fur), respiratory rate, general (i.e., decreased mobility) and provoked behavior (i.e., subdued response to stimulation), weight loss, and feces/diarrhea score combined with jejunum mucosal-injury grade score. In summary, the natural-history radio-response for murine partial-body irradiation exposures is important for establishing a well-characterized radiation model system; here we established a multiple-parameter gastrointestinal acute-radiation syndrome severity-scoring system that provides a radiation injury gastrointestinal tissue-based assessment utility.
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Affiliation(s)
- David L Bolduc
- Scientific Research Department, Armed Forces Radiobiology Research Institute
| | - Lynnette H Cary
- Scientific Research Department, Armed Forces Radiobiology Research Institute
- Pharmacology and Molecular Therapeutics
| | - Juliann G Kiang
- Scientific Research Department, Armed Forces Radiobiology Research Institute
- Pharmacology and Molecular Therapeutics
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Lalitha Kurada
- Scientific Research Department, Armed Forces Radiobiology Research Institute
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Rockville, Maryland
| | - Vidya P Kumar
- Scientific Research Department, Armed Forces Radiobiology Research Institute
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Rockville, Maryland
| | - Sunshine A Edma
- Scientific Research Department, Armed Forces Radiobiology Research Institute
| | - Matthew G Olson
- Scientific Research Department, Armed Forces Radiobiology Research Institute
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Rockville, Maryland
| | - Vernieda B Vergara
- Scientific Research Department, Armed Forces Radiobiology Research Institute
| | - Dalton D Bistline
- Scientific Research Department, Armed Forces Radiobiology Research Institute
| | - Mario Reese
- Scientific Research Department, Armed Forces Radiobiology Research Institute
| | - Doreswamy Kenchegowda
- Scientific Research Department, Armed Forces Radiobiology Research Institute
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Rockville, Maryland
| | - Maureen Hood
- Biomedical Research Imaging Core at Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Radiology & Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Alexandru Korotcov
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Rockville, Maryland
- Biomedical Research Imaging Core at Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Radiology & Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Shalini Jaiswal
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Rockville, Maryland
- Biomedical Research Imaging Core at Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Radiology & Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - William F Blakely
- Scientific Research Department, Armed Forces Radiobiology Research Institute
- Preventive Medicine and Statistics, Uniformed Services of the Health Sciences, Bethesda, Maryland
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2
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Kenchegowda D, Bolduc DL, Kurada L, Blakely WF. Severity scoring systems for radiation-induced GI injury - Prioritization for use of GI-ARS medical countermeasures. Int J Radiat Biol 2023:1-9. [PMID: 37172305 DOI: 10.1080/09553002.2023.2210669] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE Severity scoring systems for ionizing radiation-induced gastrointestinal injury have been used in animal radiation models, human studies involving the use of radiation therapy, and radiation accidents. Various radiation exposure scenarios (i.e., total body irradiation, total abdominal irradiation, etc.) have been used to investigate ionizing radiation-induced gastrointestinal injury. These radiation-induced GI severity scoring systems are based on clinical signs and symptoms and gastrointestinal-specific biomarkers (i.e., citrulline, etc.). In addition, the time course for radiation-induced changes in blood citrulline levels were compared across various animal (i.e., mice, minipigs, Rhesus Macaque, etc.) and human model systems. CONCLUSIONS A worksheet tool was developed to prioritize individuals with severe life-threatening gastrointestinal acute radiation syndrome, based on the design of the Exposure and Symptom Tool addressing hematopoietic acute radiation syndrome, to rescue individuals from potential gastrointestinal acute radiation syndrome injury. This tool provides a triage diagnostic approach to assist first-responders to assess individuals suspected of showing gastrointestinal acute radiation syndrome severity to guide medical management, hence enhancing medical readiness for managing radiological casualties.
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Affiliation(s)
- Doreswamy Kenchegowda
- Biodosimetry Program, Scientific Research Department, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - David L Bolduc
- Biodosimetry Program, Scientific Research Department, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Lalitha Kurada
- Biodosimetry Program, Scientific Research Department, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M Jackson Foundation, 6720A Rockledge Drive, Bethesda, MD USA
| | - William F Blakely
- Biodosimetry Program, Scientific Research Department, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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3
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Velikova G, Absolom K, Hewison J, Holch P, Warrington L, Avery K, Richards H, Blazeby J, Dawkins B, Hulme C, Carter R, Glidewell L, Henry A, Franks K, Hall G, Davidson S, Henry K, Morris C, Conner M, McParland L, Walker K, Hudson E, Brown J. Electronic self-reporting of adverse events for patients undergoing cancer treatment: the eRAPID research programme including two RCTs. PROGRAMME GRANTS FOR APPLIED RESEARCH 2022. [DOI: 10.3310/fdde8516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Cancer is treated using multiple modalities (e.g. surgery, radiotherapy and systemic therapies) and is frequently associated with adverse events that affect treatment delivery and quality of life. Regular adverse event reporting could improve care and safety through timely detection and management. Information technology provides a feasible monitoring model, but applied research is needed. This research programme developed and evaluated an electronic system, called eRAPID, for cancer patients to remotely self-report adverse events.
Objectives
The objectives were to address the following research questions: is it feasible to collect adverse event data from patients’ homes and in clinics during cancer treatment? Can eRAPID be implemented in different hospitals and treatment settings? Will oncology health-care professionals review eRAPID reports for decision-making? When added to usual care, will the eRAPID intervention (i.e. self-reporting with tailored advice) lead to clinical benefits (e.g. better adverse event control, improved patient safety and experiences)? Will eRAPID be cost-effective?
Design
Five mixed-methods work packages were conducted, incorporating co-design with patients and health-care professionals: work package 1 – development and implementation of the electronic platform across hospital centres; work package 2 – development of patient-reported adverse event items and advice (systematic and scoping reviews, patient interviews, Delphi exercise); work package 3 – mapping health-care professionals and care pathways; work package 4 – feasibility pilot studies to assess patient and clinician acceptability; and work package 5 – a single-centre randomised controlled trial of systemic treatment with a full health economic assessment.
Setting
The setting was three UK cancer centres (in Leeds, Manchester and Bristol).
Participants
The intervention was developed and evaluated with patients and clinicians. The systemic randomised controlled trial included 508 participants who were starting treatment for breast, colorectal or gynaecological cancer and 55 health-care professionals. The radiotherapy feasibility pilot recruited 167 patients undergoing treatment for pelvic cancers. The surgical feasibility pilot included 40 gastrointestinal cancer patients.
Intervention
eRAPID is an online system that allows patients to complete adverse event/symptom reports from home or hospital. The system provides immediate severity-graded advice based on clinical algorithms to guide self-management or hospital contact. Adverse event data are transferred to electronic patient records for review by clinical teams. Patients complete an online symptom report every week and whenever they experience symptoms.
Main outcome measures
In systemic treatment, the primary outcome was Functional Assessment of Cancer Therapy – General, Physical Well-Being score assessed at 6, 12 and 18 weeks (primary end point). Secondary outcomes included cost-effectiveness assessed through the comparison of health-care costs and quality-adjusted life-years. Patient self-efficacy was measured (using the Self-Efficacy for Managing Chronic Diseases 6-item Scale). The radiotherapy pilot studied feasibility (recruitment and attrition rates) and selection of outcome measures. The surgical pilot examined symptom report completeness, system actions, barriers to using eRAPID and technical performance.
Results
eRAPID was successfully developed and introduced across the treatments and centres. The systemic randomised controlled trial found no statistically significant effect of eRAPID on the primary end point at 18 weeks. There was a significant effect at 6 weeks (adjusted difference least square means 1.08, 95% confidence interval 0.12 to 2.05; p = 0.028) and 12 weeks (adjusted difference least square means 1.01, 95% confidence interval 0.05 to 1.98; p = 0.0395). No between-arm differences were found for admissions or calls/visits to acute oncology or chemotherapy delivery. Health economic analyses over 18 weeks indicated no statistically significant difference between the cost of the eRAPID information technology system and the cost of usual care (£12.28, 95% confidence interval –£1240.91 to £1167.69; p > 0.05). Mean differences were small, with eRAPID having a 55% probability of being cost-effective at the National Institute for Health and Care Excellence-recommended cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained. Patient self-efficacy was greater in the intervention arm (0.48, 95% confidence interval 0.13 to 0.83; p = 0.0073). Qualitative interviews indicated that many participants found eRAPID useful for support and guidance. Patient adherence to adverse-event symptom reporting was good (median compliance 72.2%). In the radiotherapy pilot, high levels of consent (73.2%) and low attrition rates (10%) were observed. Patient quality-of-life outcomes indicated a potential intervention benefit in chemoradiotherapy arms. In the surgical pilot, 40 out of 91 approached patients (44%) consented. Symptom report completion rates were high. Across the studies, clinician intervention engagement was varied. Both patient and staff feedback on the value of eRAPID was positive.
Limitations
The randomised controlled trial methodology led to small numbers of patients simultaneously using the intervention, thus reducing overall clinician exposure to and engagement with eRAPID. Furthermore, staff saw patients across both arms, introducing a contamination bias and potentially reducing the intervention effect. The health economic results were limited by numbers of missing data (e.g. for use of resources and EuroQol-5 Dimensions).
Conclusions
This research provides evidence that online symptom monitoring with inbuilt patient advice is acceptable to patients and clinical teams. Evidence of patient benefit was found, particularly during the early phases of treatment and in relation to self-efficacy. The findings will help improve the intervention and guide future trial designs.
Future work
Definitive trials in radiotherapy and surgical settings are suggested. Future research during systemic treatments could study self-report online interventions to replace elements of traditional follow-up care in the curative setting. Further research during modern targeted treatments (e.g. immunotherapy and small-molecule oral therapy) and in metastatic disease is recommended.
Trial registration
The systemic randomised controlled trial is registered as ISRCTN88520246. The radiotherapy trial is registered as ClinicalTrials.gov NCT02747264.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Galina Velikova
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kate Absolom
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Patricia Holch
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
- Psychology Group, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Lorraine Warrington
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Kerry Avery
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hollie Richards
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jane Blazeby
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bryony Dawkins
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Hulme
- Health Economics Group, Institute of Health Research, University of Exeter, Exeter, UK
| | - Robert Carter
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Liz Glidewell
- Department of Health Sciences, University of York, York, UK
| | - Ann Henry
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kevin Franks
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Geoff Hall
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Karen Henry
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| | - Lucy McParland
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Katrina Walker
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Eleanor Hudson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Julia Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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4
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White KL, Henson CC, Hann M, Eden M, Burden ST, Lal S, Davidson SE, McLaughlin JT. Randomised clinical trial of a gastrointestinal care bundle to reduce symptoms in patients with pelvic cancer undergoing chemoradiotherapy. BMJ Open Gastroenterol 2021; 7:bmjgast-2020-000432. [PMID: 32771983 PMCID: PMC7418694 DOI: 10.1136/bmjgast-2020-000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Pelvic radiotherapy is used to treat 17 000 people in the UK each year. Eight in 10 develop difficult bowel problems during pelvic treatment, especially diarrhoea, urgency and incontinence. Some cannot complete treatment, reducing the chance of cancer cure. Undertaking gastroenterologist-led investigation and management during pelvic radiotherapy has never been evaluated. In this study, we aimed to assess whether patients could successfully receive a novel gastrointestinal (GI) care bundle during chemoradiotherapy (feasibility aim) and would experience reduced symptom severity (clinical impact aim). DESIGN This randomised controlled trial recruited patients with cervical and bladder cancers undergoing radical chemoradiotherapy. Participants were randomised to intervention or control groups. Questionnaire and anthropometric data were collected. All intervention group patients received individualised dietary counselling weekly throughout treatment, and if bowel symptoms developed they were offered rapid-access investigation and treatment for any identified pathology: lactose intolerance, bacterial overgrowth or bile acid malabsorption. RESULTS Feasibility: 50 participants were recruited, 24 were randomised to the intervention group and 26 to the control group. All completed 20 fractions of external beam pelvic radiotherapy. It was possible to perform 57/72 (79%) of proposed intervention tests with no disruption of oncological management. CLINICAL IMPACT All participants developed GI symptoms during radiotherapy. The median symptom score for each group increased from baseline at 6 weeks. This was from 0.156 (0.000-0.333) to 0.600 (0.250-1.286) in the control group, and from 0.00 (0.000-0.300) to 0.402 (0.000-0.667) in the intervention group. CONCLUSION It was feasible to recruit to and deliver a randomised controlled trial of interventions in patients undergoing pelvic chemoradiotherapy. Lower median bowel scores were reported in the intervention group at 6 weeks, with fewer patients experiencing symptoms overall. TRIAL REGISTRATION NUMBER ISRCTN783488.
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Affiliation(s)
- Katherine L White
- Gastroenterology, Manchester Foundation Trust, Wythenshawe Hospital, Manchester, UK.,Manchester Academic Health Sciences Centre, Health Innovation Manchester, Manchester, UK
| | - Caroline C Henson
- Gastroenterology, Manchester Foundation Trust, Wythenshawe Hospital, Manchester, UK.,Manchester Academic Health Sciences Centre, Health Innovation Manchester, Manchester, UK
| | - Mark Hann
- Manchester Academic Health Sciences Centre, Health Innovation Manchester, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Martin Eden
- Manchester Academic Health Sciences Centre, Health Innovation Manchester, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Sorrel T Burden
- Manchester Academic Health Sciences Centre, Health Innovation Manchester, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Salford Royal Foundation Trust, Salford, UK
| | - Simon Lal
- Manchester Academic Health Sciences Centre, Health Innovation Manchester, Manchester, UK.,Salford Royal Foundation Trust, Salford, UK
| | - Susan E Davidson
- Manchester Academic Health Sciences Centre, Health Innovation Manchester, Manchester, UK.,Christie NHS Foundation Trust, Manchester, UK
| | - John T McLaughlin
- Manchester Academic Health Sciences Centre, Health Innovation Manchester, Manchester, UK .,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Salford Royal Foundation Trust, Salford, UK
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5
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Lin S, Shen Y. The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: A systematic review and meta-analysis based on 23 randomized studies. Int J Surg 2020; 84:69-77. [DOI: 10.1016/j.ijsu.2020.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 01/05/2023]
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6
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Qiu G, Yu Y, Wang Y, Wang X. The significance of probiotics in preventing radiotherapy-induced diarrhea in patients with cervical cancer: A systematic review and meta-analysis. Int J Surg 2019; 65:61-69. [PMID: 30928672 DOI: 10.1016/j.ijsu.2019.03.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/01/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
AIMS A systematic review and meta-analysis was designed to evaluate the efficacy and safety of probiotics for prevention of radiotherapy-induced diarrhea (RID) in patients with cervical cancer. Previous studies failed to give a comprehensive analysis of the efficacy and safety of probiotics in this point. METHODS We searched the Cochrane Library, PubMed, EMBASE and Web of Science up to June 4, 2018. We also hand searched some studies included in previous reviews. Our primary outcome aims to compare the incidence of all Common Toxicity Criteria (CTC) grades of RID and adverse events (AEs) in both probiotics groups and placebo groups. Relative risk (RR) with its 95% confidence interval (CI) was used to compare the efficacy of probiotics in prevention of RID, and the pooled RRs were estimated using a fixed- or random-effect model; heterogeneity was assessed with Cochran's Q and Higgins I2 test. Two reviewers assessed trial quality and extracted data independently. The analysis and bias for each of included studies were performed and assessed using Review Manager 5.2. RESULTS Nine randomized, placebo-controlled studies (N = 1508 participants) were included for assessing the efficacy of probiotics. Compared with placebo groups, participants in probiotic groups experienced much lower incidence of RID with RR of 0.61 (95% CI 0.46-0.81; P = 0.0007). In addition, significant results were also observed in CTC grade ≥2 and grade ≥3 RID, with the pooled RRs of 0.52 (95% CI 0.30-0.98; P = 0.02) and 0.32 (95% CI 0.12-0.82; P = 0.02) respectively. Eight studies, included 1410 participants (726 consuming probiotics, 657 consuming placebo, 27 lost to follow-up), were used for the analysis of safety of probiotics. Of the 8 studies, 4 studies had no AEs caused by probiotics, while another 4 studies reported varying degrees of AEs during their treatment. CONCLUSIONS Probiotics may have a beneficial effect in prevention of RID generally, especially for Grade ≥2 or 3 diarrhea. Probiotics may be safe and rarely cause severe AEs during treatment.
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Affiliation(s)
- Guijing Qiu
- Department of Gynecology, Tiantai Branch of Zhejiang Provincial People's Hospital, Tiantai, 317200, China
| | - Yan Yu
- Department of Gynecology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Yanpeng Wang
- Department of Gynecology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Xinyan Wang
- Department of Gynecology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China.
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7
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van den Blink QU, Garcez K, Henson CC, Davidson SE, Higham CE, Cochrane Gynaecological, Neuro‐oncology and Orphan Cancer Group. Pharmacological interventions for the prevention of insufficiency fractures and avascular necrosis associated with pelvic radiotherapy in adults. Cochrane Database Syst Rev 2018; 4:CD010604. [PMID: 29683475 PMCID: PMC6494432 DOI: 10.1002/14651858.cd010604.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pelvic radiotherapy is a treatment delivered to an estimated 150,000 to 300,000 people annually across high-income countries. Fractures due to normal stresses on weakened bone due to radiotherapy are termed insufficiency fractures. Pelvic radiotherapy-related interruption of the blood supply to the hip is termed avascular necrosis and is another recognised complication. The reported incidences of insufficiency fractures are 2.7% to 89% and risk of developing avascular necrosis is 0.5%. These complications lead to significant morbidity in terms of pain, immobility and consequently risk of infections, pressure sores and mortality. OBJECTIVES To assess the effects of pharmacological interventions for preventing insufficiency fractures and avascular necrosis in adults over 18 years of age undergoing pelvic radiotherapy. SEARCH METHODS We performed electronic literature searches in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and DARE to 19 April 2017. We also searched trial registries. Further relevant studies were identified through handsearching of citation lists of included studies. SELECTION CRITERIA Randomised controlled trials (RCTs) or non RCTs with concurrent comparison groups including quasi-RCTs, cluster RCTs, prospective cohort studies and case series of 30 or more participants were screened. We included studies assessing the effect of pharmacological interventions in adults over 18 years of age undergoing radical pelvic radiotherapy as part of anticancer treatment for a primary pelvic malignancy. We excluded studies involving radiotherapy for bone metastases. We assessed use of pharmacological interventions at any stage before or during pelvic radiotherapy. Interventions included calcium or vitamin D (or both) supplementation, bisphosphonates, selective oestrogen receptor modulators, hormone replacement therapy (oestrogen or testosterone), denosumab and calcitonin. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We contacted study authors to obtain missing data. Data were to be pooled using the random-effects model if study comparisons were similar, otherwise results were to be reported narratively. MAIN RESULTS We included two RCTs (1167 participants). The first RCT compared zoledronic acid with placebo in 96 men undergoing pelvic radiotherapy for non-metastatic prostate cancer.The second RCT had four treatment arms, two of which evaluated zoledronic acid plus adjuvant androgen suppression compared with androgen suppression only in 1071 men undergoing pelvic radiotherapy for non-metastatic prostate cancer.Both studies were at a moderate to high risk of bias and all evidence was judged to be of very low certainty.The studies provided no evidence on the primary outcomes of the review and provided limited data in relation to secondary outcomes, such that meta-analyses were not possible. Both studies focused on interventions to improve bone health in relation to androgen deprivation rather than radiation-related insufficiency fractures and avascular necrosis. Few fractures were described in each study and those described were not specific to insufficiency fractures secondary to radiotherapy. Both studies reported that zoledronic acid in addition to androgen deprivation and pelvic radiotherapy led to improvements in BMD; however, the changes in BMD were measured and reported differently. There was no available evidence regarding adverse effects. AUTHORS' CONCLUSIONS The evidence relating to interventions to prevent insufficiency fractures and avascular necrosis associated with pelvic radiotherapy in adults is of very low certainty. This review highlights the need for prospective clinical trials using interventions prior to and during radiotherapy to prevent radiation-related bone morbidity, insufficiency fractures and avascular necrosis. Future trials could involve prospective assessment of bone health including BMD and bone turnover markers prior to pelvic radiotherapy. The interventions for investigation could begin as radiotherapy commences and remain ongoing for 12 to 24 months. Bone turnover markers and BMD could be used as surrogate markers for bone health in addition to radiographic imaging to report on presence of insufficiency fractures and development of avascular necrosis. Clinical assessments and patient reported outcomes would help to identify any associated adverse effects of treatment and quality of life outcomes.
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Affiliation(s)
- Qurrat U van den Blink
- The Christie NHS Foundation TrustRadiotherapy‐related ResearchWilmslow RoadManchesterGreater ManchesterUKM20 4BX
| | - Kate Garcez
- The Christie NHS Foundation TrustClinical OncologyWilmslow RoadManchesterUKM20 4BX
| | - Caroline C Henson
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe HospitalGastroenterologySouthmoor RoadWythenshaweManchesterLancashireUKM23 9LT
| | - Susan E Davidson
- The Christie NHS Foundation TrustClinical OncologyWilmslow RoadManchesterUKM20 4BX
| | - Claire E Higham
- The Christie NHS Foundation TrustEndocrinologyWilmslow RoadManchesterGreater ManchesterUKM20 4BX
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8
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Wang YH, Yao N, Wei KK, Jiang L, Hanif S, Wang ZX, Pei CX. The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: a systematic review and meta-analysis. Eur J Clin Nutr 2016; 70:1246-1253. [PMID: 27329608 DOI: 10.1038/ejcn.2016.102] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/05/2016] [Accepted: 05/14/2016] [Indexed: 01/07/2023]
Abstract
A systematic review and meta-analysis were designed to evaluate the efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer. We searched the Cochrane Library, PubMed, EMBASE and Web of Science up to November 2015. We also hand searched the citation lists of included studies and previously identified systematic reviews to identify further relevant trials. Odds ratio (OR) was used to compare efficacy, and the pooled OR was estimated using a random effects model; heterogeneity was assessed with Cochran's Q and the Higgins' I2-test. Two reviewers assessed trial quality and extracted data independently. Analysis and bias for each included study were performed using Review Manager 5.2. Nine randomized and placebo-controlled studies (N=1265 participants) were included for assessing efficacy, of which seven were about radiotherapy and two about chemotherapy. Probiotic groups were compared with control groups with respect to the the incidence of diarrhea, OR=0.47 (95% confidence interval 0.28-0.76; P=0.002). Eleven studies, including 1612 people (873 consuming probiotics and 739 not consuming probiotics), were used for the analysis of safety of probiotics. Of the 11 studies, seven studies had no adverse events (AEs) caused by probiotics, whereas four studies reported varying degrees of AEs in their treatment. Probiotics may have a beneficial effect in prevention of chemoradiotherapy-induced diarrhea generally, especially for Grade⩾2 diarrhea. Probiotics may rarely cause AEs.
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Affiliation(s)
- Y-H Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - N Yao
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - K-K Wei
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - L Jiang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - S Hanif
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Z-X Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Evidence Based Medical Centre of Lanzhou University, Lanzhou, China
| | - C-X Pei
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Evidence Based Medical Centre of Lanzhou University, Lanzhou, China
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Advances in understanding and improving gastrointestinal symptoms during supportive and palliative care: a decade of progress. Curr Opin Support Palliat Care 2016; 10:149-51. [PMID: 27054289 DOI: 10.1097/spc.0000000000000215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Boulton M, Adams E, Horne A, Durrant L, Rose P, Watson E. A qualitative study of cancer survivors’ responses to information on the long-term and late effects of pelvic radiotherapy 1-11 years post treatment. Eur J Cancer Care (Engl) 2015. [DOI: 10.1111/ecc.12356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M. Boulton
- Department of Clinical Health Care; Oxford Brookes University; Oxford UK
| | - E. Adams
- School of Psychology; College of Life Sciences; Birmingham University; Birmingham UK
| | - A. Horne
- Oxford University Hospitals NHS Trust; Department of Radiotherapy; Oxford Cancer and Haematology Centre; Churchill Hospital; Oxford UK
| | - L. Durrant
- Oxford University Hospitals NHS Trust; Department of Radiotherapy; Oxford Cancer and Haematology Centre; Churchill Hospital; Oxford UK
| | - P. Rose
- Department of Primary Health Care Sciences; University of Oxford; Oxford UK
| | - E. Watson
- Department of Clinical Health Care; Oxford Brookes University; Oxford UK
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11
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Adams E, Boulton M, Horne A, Rose P, Durrant L, Collingwood M, Oskrochi R, Davidson S, Watson E. The Effects of Pelvic Radiotherapy on Cancer Survivors: Symptom Profile, Psychological Morbidity and Quality of Life. Clin Oncol (R Coll Radiol) 2014; 26:10-7. [DOI: 10.1016/j.clon.2013.08.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 06/17/2013] [Accepted: 06/18/2013] [Indexed: 01/03/2023]
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12
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Outcome and patient-reported toxicity in localised prostate cancer treated with dose-escalated hypofractionated intensity-modulated radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2013. [DOI: 10.1017/s146039691200043x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo report outcomes and late toxicity for a hypofractionated dose-escalated radiotherapy schedule in patients treated using intensity-modulated radiotherapy (IMRT) for localised prostate cancer.Materials and methodsEighty-eight men with localised prostate cancer were treated with 57 Gy in 19 daily fractions over 4 weeks. A total of 70 out of 88 had high-risk disease. Overall survival, cause-specific survival and biochemical progression-free survival (bPFS, Phoenix definition) were reported. Toxicity was measured retrospectively using Radiation Therapy Oncology Group (RTOG) criteria and assessed prospectively with a validated Late Effects in Normal Tissues Subjective, Objective, Management and Analytic (LENT/SOMA) patient questionnaire.ResultsAt 5 years, overall survival was 84%, cause-specific survival 88% and bPFS 65%. In patients with high-risk disease, 5-year bPFS was 62%. There was no RTOG toxicity above grade III. LENT/SOMA questionnaires were returned by 74% patients. Median scores for bowel and urinary function were <1. Maximum bowel and urinary toxicity scores ≥2 were reported by 64% and 59% of patients, respectively. The median score for sexual function was 1·5, but nearly all (96%) patients recorded a toxicity score ≥2 for at least one question.ConclusionsDose-escalated hypofractionated radiotherapy delivered using IMRT has promising outcomes and acceptable late toxicity. This fractionation schedule is being compared with conventional treatment within an on-going multicentre phase III clinical trial.
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Henson CC, Burden S, Davidson SE, Lal S, Cochrane Gynaecological, Neuro‐oncology and Orphan Cancer Group. Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy. Cochrane Database Syst Rev 2013; 2013:CD009896. [PMID: 24282062 PMCID: PMC11748115 DOI: 10.1002/14651858.cd009896.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Across the developed world, an estimated 150,000 to 300,000 people are treated annually with pelvic radiotherapy and 80% will develop gastrointestinal (GI) symptoms during treatment. Acute GI symptoms are associated with a greater risk of chronic, often debilitating, GI symptoms. Up to one-third of patients are malnourished before pelvic radiotherapy and up to four-fifths of patients lose weight during treatment. Malnutrition is linked to a higher risk of GI toxicity, which can lead to breaks in radiotherapy and early cessation of chemotherapy, thus compromising the efficacy of the primary cancer treatment. OBJECTIVES To assess the effects of nutritional interventions for reducing GI toxicity in adults undergoing radical pelvic radiotherapy. SEARCH METHODS We searched the Cochrane Gynaecological Cancer Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 4, 2012, MEDLINE and EMBASE to May 2012. We handsearched the citation lists of included studies and previous systematic reviews identified to identify further relevant trials. SELECTION CRITERIA We included studies if they were randomised controlled trials (RCTs) or non-randomised studies with concurrent comparison groups including quasi-randomised trials, cluster RCTs, non-randomised trials, prospective and retrospective cohort studies, and case series of 30 or more patients. We only included studies if they assessed the effect of a nutritional intervention in adults aged 18 years or over undergoing radical pelvic radiotherapy as part of anticancer treatment for a primary pelvic malignancy. We excluded patients with stomas and a previous history of inflammatory bowel disease. Nutritional support interventions could be provided at any stage before or during pelvic radiotherapy and included dietary counselling; dietary modification of fibre, lactose or fat; supplementary foods or drinks or fortified foods; standard oral nutrition supplements including polymeric-, peptide- or amino acid-based supplements and those where novel substrates have been added; enteral tube feeds; or parenteral nutrition (partial or total). We excluded probiotics, prebiotics and synbiotics. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We contacted study authors to obtain missing data. We assessed bias for each of the included studies using the bias assessment tables in the Cochrane software Review Manager5. We performed meta-analysis, when indicated, using the Mantel-Haenszel fixed-effect method or inverse variance fixed-effect method displayed with heterogeneity. We undertook meta-analyses on trials evaluating dietary modification against standard treatment for diarrhoea at the end of radiotherapy and for change in weight from baseline to end of radiotherapy. MAIN RESULTS The searches identified 7558 titles, and we excluded 7513 during title and abstract searches. We reviewed 45 papers in full, and excluded 39. We identified four studies on handsearching of the references, which, along with the six eligible papers from the database search, led to 10 studies being included. Four studies, three of which were RCTs and one prospective study, investigated the effect of elemental diet on GI symptoms; one RCT investigated the effect of dietary modification and elemental diet; and five RCTs investigated dietary modification. Studies were varied in terms of risk of bias. Data were dichotomised for presence and absence of diarrhoea at the end of radiotherapy for four trials evaluating dietary modification comprising modified fat, lactose, fibre or combinations of these dietary changes. A reduction in diarrhoea was demonstrated with nutritional intervention (risk ratio (RR) 0.66; 95% confidence interval (CI) 0.51 to 0.87, four studies, 413 participants, moderate quality of evidence) with low heterogeneity (Chi(2) = 3.50, I(2) = 14%). Two trials evaluating dietary modification on weight change (comparing baseline and end of radiotherapy) showed no difference between intervention or control (mean difference (MD) -0.57 kg; 95% CI -1.22 to 0.09) with low heterogeneity (Chi(2) = 1.41, I(2) = 29%). Generally adverse effects were poorly reported in included studies. Elemental diet in particular was poorly tolerated. GI symptoms or toxicity > 6 months after radiotherapy was not reported in included studies AUTHORS' CONCLUSIONS There have been benefits demonstrated with dietary modification during pelvic radiotherapy to reduce diarrhoea. Those diets included single interventions or combinations of modified fat, lactose-restriction, fat-restriction and fibre supplementation. We were unable to meta-analyse elemental diet, as data were not available. We considered some of the studies to be at high risk of bias. There have been recent advances in novel, more targeted radiotherapy techniques, such that the findings of older studies need to be interpreted with caution. In addition, there were problems with compliance and palatability with some of the interventions, particularly elemental diet, which limits its usefulness in clinical practice.
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Affiliation(s)
- Caroline C Henson
- Royal Bolton HospitalGastroenterologyMinerva RdFarnworthBoltonLancashireUKBL4 0JR
| | - Sorrel Burden
- University of ManchesterSchool of Nursing, Midwifery and Social WorkRoom 6.32, Jean McFarlane Building, Oxford RoadManchesterUKM13 9PL
| | - Susan E Davidson
- Christie Hospital NHS Foundation TrustClinical OncologyWilmslow RoadManchesterGreater ManchesterUKM20 4BX
| | - Simon Lal
- Salford Royal Foundation TrustIntestinal Failure UnitSalfordUKM6 8HD
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Kuku S, Fragkos C, McCormack M, Forbes A. Radiation-induced bowel injury: the impact of radiotherapy on survivorship after treatment for gynaecological cancers. Br J Cancer 2013; 109:1504-12. [PMID: 24002603 PMCID: PMC3777000 DOI: 10.1038/bjc.2013.491] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 07/25/2013] [Accepted: 07/30/2013] [Indexed: 01/03/2023] Open
Abstract
Background: The number of women surviving cancer who live with symptoms of bowel toxicity affecting their quality of life continues to rise. In this retrospective study, we sought to describe and analyse the presenting clinical features in our cohort, and evaluate possible predictors of severity and chronicity in women with radiation-induced bowel injury after treatment for cervical and endometrial cancers. Methods: Review of records of 541 women treated within the North London Gynaecological Cancer Network between 2003 and 2010 with radiotherapy with or without chemotherapy for cervical and endometrial cancer identified 152 women who reported significant new bowel symptoms after pelvic radiation. Results: Factor analysis showed that the 14 most common and important presenting symptoms could be ‘clustered' into 3 groups with predictive significance for chronicity and severity of disease. Median follow-up for all patients was 60 months. Univariate analysis showed increasing age, smoking, extended field radiation, cervical cancer treatment and the need for surgical intervention to be significant predictors for severity of ongoing disease at last follow-up. On multivariate analysis, only age, cancer type (cervix) and symptom combinations/‘cluster' of (bloating, flatulence, urgency, rectal bleeding and per-rectal mucus) were found to be significant predictors of disease severity. Fifteen (19%) women in the cervical cancer group had radiation-induced bowel injury requiring surgical intervention compared with five (6.7%) in the endometrial cancer group. Conclusion: Women with cervical cancer are younger and appear to suffer more severe symptoms of late bowel toxicity, whereas women treated for endometrial cancer suffer milder more chronic disease. The impact of radiation-induced bowel injury and the effect on cancer survivorship warrants further research into investigation of predictors of severe late toxicity. There is a need for prospective trials to aid early diagnosis, while identifying the underlying patho-physiological process of the bowel injury.
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Affiliation(s)
- S Kuku
- Department of Oncology, University College London Hospitals, 250 Euston Road, London NW1 2PG, UK
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15
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Mehmood QU, Garcez K, Henson CC, Davidson SE, Higham CE. Pharmacological interventions for the prevention of insufficiency fractures and avascular necrosis associated with pelvic radiotherapy in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Qurrat U Mehmood
- Christie NHS Foundation Trust; Radiotherapy-related Research; Wilmslow Road Manchester Greater Manchester UK M20 4BX
| | - Kate Garcez
- Christie Hospital NHS Foundation Trust; Clinical Oncology; Wilmslow Road Manchester UK M20 4BX
| | - Caroline C Henson
- Royal Bolton Hospital; Gastroenterology; Minerva Rd Farnworth Bolton Lancashire UK BL4 0JR
| | - Susan E Davidson
- Christie Hospital NHS Foundation Trust; Clinical Oncology; Wilmslow Road Manchester UK M20 4BX
| | - Claire E Higham
- Christie Hospital NHS Foundation Trust; Endocrinology; Wilmslow Road Manchester Greater Manchester UK M20 4BX
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16
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Structured gastroenterological intervention and improved outcome for patients with chronic gastrointestinal symptoms following pelvic radiotherapy. Support Care Cancer 2013; 21:2255-65. [DOI: 10.1007/s00520-013-1782-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 03/04/2013] [Indexed: 01/03/2023]
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17
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Abstract
PURPOSE OF REVIEW To review the evidence for candidate biomarkers of gastrointestinal toxicity following pelvic radiotherapy to highlight recent findings of potential interest to those involved in the treatment of pelvic malignancies or the management of gastrointestinal consequences of cancer treatments. RECENT FINDINGS Multiple serum and faecal biomarkers have been studied for use in the detection of gastrointestinal toxicity following pelvic radiotherapy. There is no single biomarker that has been shown to be useful and studies have been hampered by the lack of a 'gold standard' test to confirm the presence of toxicity. Given the complex effects of pelvic radiotherapy on the gastrointestinal tract, it is likely that a panel of biomarkers would be necessary in clinical practice. SUMMARY Biomarkers for gastrointestinal toxicity have a potential role in determining the outcomes of current and evolving radiotherapy techniques, identifying those patients at risk of greater degrees of toxicity to facilitate individualized treatment and determining whether symptoms that develop following treatment are related to the previous radiotherapy. Outcome measurement of pelvic radiotherapy has been plagued by inaccurate terminology and crude outcome measures. An accurate and acceptable biomarker or panel of biomarkers has the potential to revolutionize cancer management from treatment planning to posttreatment care. Several candidate biomarkers show promising results, but further robust research is required to clearly identify reliable biomarkers that can be translated into clinical practice.
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18
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Gastrointestinal symptoms after pelvic radiotherapy: a national survey of gastroenterologists. Support Care Cancer 2011; 20:2129-39. [DOI: 10.1007/s00520-011-1323-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 11/01/2011] [Indexed: 10/15/2022]
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19
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White ID, Allan H, Faithfull S. Assessment of treatment-induced female sexual morbidity in oncology: is this a part of routine medical follow-up after radical pelvic radiotherapy? Br J Cancer 2011; 105:903-10. [PMID: 21897386 PMCID: PMC3185952 DOI: 10.1038/bjc.2011.339] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 07/28/2011] [Accepted: 08/02/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Oncology follow-up has traditionally prioritised disease surveillance and the assessment and management of symptoms associated with cancer and its treatment. Over the past decade, the focus on late effects of treatment has increased, particularly those that have an adverse effect on long-term function and quality of life. The aim of this research was to explore factors that influence the identification of treatment-induced female sexual difficulties in routine oncology follow-up after radical pelvic radiotherapy. METHODS A structured observation schedule was used to systematically record topics discussed in 69 radiotherapy follow-up consultations observed over a 5-month period. RESULTS Analysis suggests that physical toxicity assessment focused on bowel (81%) and bladder (70%) symptoms. Vaginal toxicity was discussed less frequently (42%) and sexual issues were explored in only 25% of consultations. Formal recording of radiation toxicity through assessment questionnaires was limited to patients participating in clinical trials. Surveillance activity and the management of active physical symptoms predominated and psychosocial issues were addressed in only 42% of consultations. INTERPRETATION Female sexual morbidity after pelvic radiotherapy remains a neglected aspect of routine follow-up and cancer survivorship. Developments in both individual practice and service provision are necessary if the identification and management of treatment-induced female sexual difficulties is to be improved.
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Affiliation(s)
- I D White
- Supportive Cancer Care Research Group, Florence Nightingale School of Nursing and Midwifery, James Clerk Maxwell Building, King's College, 57 Waterloo Road, London SE1 8WA, UK.
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Henson CC, Andreyev HJ, Symonds RP, Peel D, Swindell R, Davidson SE. Late-onset bowel dysfunction after pelvic radiotherapy: a national survey of current practice and opinions of clinical oncologists. Clin Oncol (R Coll Radiol) 2011; 23:552-7. [PMID: 21550216 DOI: 10.1016/j.clon.2011.04.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 02/21/2011] [Accepted: 02/22/2011] [Indexed: 12/23/2022]
Abstract
AIMS Seventeen thousand patients receive treatment with radical pelvic radiotherapy annually in the UK. It is common for patients to develop gastrointestinal symptoms after treatment. The aim of this study was to determine the current practice of clinical oncologists in the UK with respect to late-onset bowel dysfunction after pelvic radiotherapy, and to discuss the wider issues surrounding current and future service provision for this patient group. MATERIALS AND METHODS A questionnaire was developed to establish current practice. This was sent to the 314 clinical oncologists in the UK who treat pelvic malignancies up to a maximum of three times. RESULTS One hundred and ninety (61%) responses were received. Most oncologists (76%) screen for gastrointestinal dysfunction after pelvic radiotherapy, usually through history taking rather than formal tools. Clinical oncologists view toxicity as a significant problem, with most estimating that up to 24% of patients at 1 year have bowel symptoms. Most oncologists refer less than 50% of their symptomatic patients, with most referring less than 10%. These referrals are 31% to a gastroenterologist, 23% to a gastrointestinal surgeon and 33% to both. Most (58%) do not have access to a gastroenterologist or a gastrointestinal surgeon with a specialist interest in their area. Sixty-five per cent of oncologists think a service is required specifically for patients with bowel dysfunction after pelvic radiotherapy, but half (52%) think that the current service in their area is inadequate. CONCLUSIONS Clinical oncologists recognise late-onset bowel dysfunction after pelvic radiotherapy as a significant problem, but one that is linked to poor recognition of symptoms and an inadequate patchy service.
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Affiliation(s)
- C C Henson
- The Christie NHS Foundation Trust, Manchester, UK.
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