Nutritional interventions in acute radiation-induced diarrhoea in pelvic cancer: a systematic review
Jimmi Søndergaard,
Denmark
PO-2286
Abstract
Nutritional interventions in acute radiation-induced diarrhoea in pelvic cancer: a systematic review
Authors: Mette Overgaard Holm1, Ursula Falkmer1, Mette Karen Yilmaz2, Jimmi Søndergaard2, Randi Tobberup3, Henrik Højgaard Rasmussen4, Charlotte Lauridsen5, Asta Bye6, Laurids Østergaard Poulsen1
1Clinical Institute, Faculty of Medicine, Aalborg University, Department of Oncology, Aalborg, Denmark; 2Aalborg University Hospital, Department of Oncology, Aalborg, Denmark; 3Center for Nutrition and Bowel Failure, Department of Gastroenterology, Aalborg, Denmark; 4Clinical Institute, Faculty of Medicine, Aalborg University, Center for Nutrition and Bowel Failure, Aalborg, Denmark; 5Aarhus University, Department of Animal and Veterinary Sciences, Foulum, Denmark; 6Oslo University Hospital, Department of Oncology, Oslo, Norway
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Purpose or Objective
A well-known side effect of EBRT to the pelvis is acute radiation-induced diarrhoea (RID). RID is reported as the problem with the greatest impact on HRQOL. In about 80% of patients receiving pelvic RT loose stool has been reported, usually occurring two weeks after the start of EBRT and peaks at 4-5 weeks post irradiation. Recently, a systematic review showed low evidence that protein supplements, dietary counselling and probiotics may reduce acute RID. The aim of the current review is to investigate if there is any evidence for nutritional interventions improving acute RID in patients with pelvic cancer during curative RT.
Material and Methods
The Cochrane technology platform Covidence was used. PROSPERO registration (ID: CRD42020209499). Databases searched were PubMed, Embase, Cinahl and Cochrane Library from January 1st 2005 to October 10th 2022. Included were RCT’s or prospective observational studies, including ≥20 patients, published in English. Search terms were primary pelvic cancer, curative EBRT, acute RID, nutritional interventions, antidiarrheal agents, and gastrointestinal toxicity. Risk of bias (RoB) was assessed with the Cochrane RoB tool. Improved or unchanged effect on acute RID appears as up or horizontal arrows, respectively. The quality of evidence (QE) was graded using the GRADE system, categorized as high, moderate, or low (Table 1).
Results
The literature retrieved, see Fig. 1. The 21 studies included a total of 2,225 patients with pelvic cancer, sample from 26-490, 20 RCTs and one observational trial. In almost all studies, patients with different cancer types were treated with different RT techniques. Nutritional interventions were probiotics (n=6), prebiotics (n=6), glutamine (n=4), and others (n=5). Most RoB was noticed because “incomplete outcome data” and other bias due to several cancer diagnoses, RID not defined as primary endpoint, few patients, unclear nutritional interventions, different RT’s, and adapted Bristol Stool Scales (Table 1). Six probiotic trials showed improvement of acute RID in 5 studies. The common probiotic interventions were given in solid form containing Lactobacillus acidophilus and different Bifidobacterium species.
Conclusion
In all 15 of the 21 included studies have high RoB. Low patient numbers; clinical heterogeneity including multiple cancer diagnoses and radiotherapy regimes; and non-systematic assessment of acute RID seem to be the main reasons for low quality of evidence. However, five probiotics studies were identified, two of them with high quality of evidence, with improvement of acute RID, all of them using a combination of different probiotics. Future well-designed clinical studies investigating the effect of probiotics on acute RID should be done.