Clinical Oncology xxx (2014) 1 Contents lists available at ScienceDirect
Clinical Oncology journal homepage: www.clinicaloncologyonline.net
Letter
Diarrhoea and Pelvic Irradiation: A Neglected Issue Sir d In a recent issue of Clinical Oncology, Adams et al. [1] reported on 418 patients previously submitted to curative pelvic radiotherapy with the aim to investigate the patientreported long-term toxicities. In particular, they observed a relatively high rate of gastrointestinal disturbances (i.e. bowel urgency, diarrhoea). The authors affirmed that patients may feel reluctant to discuss bowel symptoms with their doctor and this could justify the low referring rate to a gastroenterologist. In a recent published paper [2], we reported on the incidence of diarrhoea in patients submitted to radiotherapy in an Italian multicentre study. We observed that anti-diarrhoea treatment was given in 56.2% of patients with diarrhoea and in the remaining 43.8% of cases no drug or dietary measures were given. These data seem to confirm the poor recognition of symptom diarrhoea among oncologists [1,3]. This pattern of the low use of anti-diarrhoea drugs may be due to an underestimation of the clinical relevance of treatment-induced diarrhoea. It may be possible, however, that some of those patients did not declare the diarrhoea to the oncologist because their quality of life did not deteriorate. In that case, they did not need any specific measure. It is noteworthy that in both studies [1,2], the scarce oncologists’ attention with respect to intestinal symptoms emerges. Do Adams et al. have data on the incidence of acute intestinal toxicities (during previous irradiation) among the patients studied? In fact, it seems that the severity of acute bowel toxicity may predetermine the degree of chronic bowel changes [4] but, to date, there is no demonstration that an early intervention to prevent or reduce acute toxicity [5,6] can reduce the incidence of late intestinal toxicities. We think it is important for the authors to comment on these issues and perhaps reply within the context of this journal.
S. Pergolizzi*, E. Maranzanoy, A. Santacaterinaz * Department of Radiological Science, University of Messina, Messina, Italy y z
Radiotherapy Centre, “S. Maria” Hospital, Terni, Italy
Operative Unit of Radiation Oncology, Azienda Ospedaliera PapardoPiemonte, Messina, Italy
References [1] Adams E, Boulton MG, Horney A, et al. The effects of pelvic radiotherapy on cancer survivors: symptom profile, psychological morbidity and quality of life. Clin Oncol 2014;26:10e17. [2] Pergolizzi S, Maranzano E, De Angelis V, et al. Diarrhoea in irradiated patients: a prospective multicentre observational study. Dig Liver Dis 2013;45:933e937. [3] 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 2011;23:552e557. [4] Donaldson S, Jundt S, Ricour C, et al. Radiation enteritis in children. A retrospective review, clinicopathologic correlation and dietary management. Cancer 1975;35:1167e1178. [5] Delia P, Sansotta G, Donato V, et al. Prophylaxis of diarrhea in patients submitted to radiotherapeutic treatment on pelvic district: personal experience. Dig Liver Dis 2002;34(Suppl. 2):584e586. [6] Delia P, Sansotta G, Donato V, et al. Prevention of radiationinduced diarrhea with the use of VSL#3, a new highpotency probiotic preparation. Am J Gastroenterol 2002;97:2150e2152.
0936-6555/$36.00 Ó 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.clon.2014.05.010
Please cite this article in press as: Pergolizzi S, et al., Diarrhoea and Pelvic Irradiation: A Neglected Issue, Clinical Oncology (2014), http:// dx.doi.org/10.1016/j.clon.2014.05.010
Clinical Oncology journal homepage: www.clinicaloncologyonline.net
Letter
Diarrhoea and Pelvic Irradiation: A Neglected Issue Sir d In a recent issue of Clinical Oncology, Adams et al. [1] reported on 418 patients previously submitted to curative pelvic radiotherapy with the aim to investigate the patientreported long-term toxicities. In particular, they observed a relatively high rate of gastrointestinal disturbances (i.e. bowel urgency, diarrhoea). The authors affirmed that patients may feel reluctant to discuss bowel symptoms with their doctor and this could justify the low referring rate to a gastroenterologist. In a recent published paper [2], we reported on the incidence of diarrhoea in patients submitted to radiotherapy in an Italian multicentre study. We observed that anti-diarrhoea treatment was given in 56.2% of patients with diarrhoea and in the remaining 43.8% of cases no drug or dietary measures were given. These data seem to confirm the poor recognition of symptom diarrhoea among oncologists [1,3]. This pattern of the low use of anti-diarrhoea drugs may be due to an underestimation of the clinical relevance of treatment-induced diarrhoea. It may be possible, however, that some of those patients did not declare the diarrhoea to the oncologist because their quality of life did not deteriorate. In that case, they did not need any specific measure. It is noteworthy that in both studies [1,2], the scarce oncologists’ attention with respect to intestinal symptoms emerges. Do Adams et al. have data on the incidence of acute intestinal toxicities (during previous irradiation) among the patients studied? In fact, it seems that the severity of acute bowel toxicity may predetermine the degree of chronic bowel changes [4] but, to date, there is no demonstration that an early intervention to prevent or reduce acute toxicity [5,6] can reduce the incidence of late intestinal toxicities. We think it is important for the authors to comment on these issues and perhaps reply within the context of this journal.
S. Pergolizzi*, E. Maranzanoy, A. Santacaterinaz * Department of Radiological Science, University of Messina, Messina, Italy y z
Radiotherapy Centre, “S. Maria” Hospital, Terni, Italy
Operative Unit of Radiation Oncology, Azienda Ospedaliera PapardoPiemonte, Messina, Italy
References [1] Adams E, Boulton MG, Horney A, et al. The effects of pelvic radiotherapy on cancer survivors: symptom profile, psychological morbidity and quality of life. Clin Oncol 2014;26:10e17. [2] Pergolizzi S, Maranzano E, De Angelis V, et al. Diarrhoea in irradiated patients: a prospective multicentre observational study. Dig Liver Dis 2013;45:933e937. [3] 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 2011;23:552e557. [4] Donaldson S, Jundt S, Ricour C, et al. Radiation enteritis in children. A retrospective review, clinicopathologic correlation and dietary management. Cancer 1975;35:1167e1178. [5] Delia P, Sansotta G, Donato V, et al. Prophylaxis of diarrhea in patients submitted to radiotherapeutic treatment on pelvic district: personal experience. Dig Liver Dis 2002;34(Suppl. 2):584e586. [6] Delia P, Sansotta G, Donato V, et al. Prevention of radiationinduced diarrhea with the use of VSL#3, a new highpotency probiotic preparation. Am J Gastroenterol 2002;97:2150e2152.
0936-6555/$36.00 Ó 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.clon.2014.05.010
Please cite this article in press as: Pergolizzi S, et al., Diarrhoea and Pelvic Irradiation: A Neglected Issue, Clinical Oncology (2014), http:// dx.doi.org/10.1016/j.clon.2014.05.010
