Radiotherapy-induced damage to noncancerous 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 for the prevention and management of symptoms.
Dr Andreyev and colleagues from the United Kingdom synthesized the evidence for the use of elemental formula low- or modified-fat diets, fibre, lactose restriction and probiotics, prebiotics and synbiotics to protect the gastrointestinal tract during pelvic radiotherapy.
The research team searched 4 electronic databases.
|Study quality was variable with only 37% scoring 10 points or more|
|Alimentary Pharmacology & Therapeutics|
Randomized controlled trials, controlled trials, and case series in adult patients receiving radiotherapy for pelvic cancers employing nutritional interventions to reduce gastrointestinal toxicity were included.
Methodological quality was assessed using a bespoke tool.
The researchers identified 22 original studies.
Study quality was highly variable with only 37% scoring 10 points or more.
Few studies assessed compliance with the intervention.
End-points varied and included symptom scales.
Evidence from randomized controlled trials was weak for elemental, low- or modified-fat, fibre and low-lactose interventions with 1/4, 3/4, 1/2, 0/1 trials, respectively, reporting favorable outcomes.
The team found that evidence for probiotics as prophylactic interventions was more promising, but dose, strains and methodologies varied.
Dr Andreyev's team concludes, "There is insufficient high-grade evidence to recommend nutritional intervention during pelvic radiotherapy."
"Total replacement of diet with elemental formula may be appropriate in severe toxicity."
"Probiotics offer promise, but cannot be introduced into clinical practice without rigorous safety analysis, not least in immunocompromised patients."
"The methodological quality of nutritional intervention studies needs to be improved."