Welcome to our second edition – back in COVID-19 lockdown, as if cancer and Pelvic Radiation Disease (PRD) aren’t challenging enough…
Clearly the NHS is still very much stretched, and services are far from normal. None the less, there are some very good articles about the late effects of pelvic radiotherapy, and my selection shows that there is more international interest in this topic, which is very heartening.
Please send suggestions for inclusion in the next feature to ResearchNews@prda.org.uk.
Dr Tim Ward, Scientific Consultant Advisor, Pelvic Radiation Disease Association.
Please note that the links below take you to the article abstracts, and that the full articles may be paywalled and only accessible by people who work for institutions with journal subscriptions.
Urological consequences of pelvic radiotherapy
First to be highlighted is a plenary session at the American Urologic Association 2020 Virtual Annual Meeting which was entitled “Is Radiotherapy the Devil’s Work?”. Essentially a walk through the urological consequences of pelvic radiation treatment, this mainly covers prostate cancer but is relevant to any cancer treated with pelvic radiotherapy. Interestingly, one slide quoted Prof Jervoise Andreyev’s definition of Pelvic Radiation Disease. It’s encouraging to see US clinicians being exposed to this term – hopefully PRD will be more widely adopted into medical terminology.
Care bundle early in treatment pathway
Next is a very interesting paper from the Manchester research group involving Dr Caroline Henson who is on PRDA’s Medical Advisory Panel: Randomised clinical trial of a gastrointestinal care bundle to reduce symptoms in patients with pelvic cancer undergoing chemoradiotherapy. In this preliminary feasibility study, participants about to undergo pelvic radiotherapy were randomised to intervention or control groups. All intervention group patients received individualised dietary counselling weekly throughout cancer 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. This study found that a care bundle was acceptable to patients with no disruption to cancer treatment. A full study is needed to confirm the benefits, but it is very promising that this care bundle could help more patients manage bowel symptoms, and thus prevent deterioration in quality of life. PRDA looks forward with great interest to the full study.
Bowel problems related to gynaecological cancers
Ann Muls (also a member of PRDA’s Medical Advisory Panel) and colleagues have published a study A proposed tailored investigational algorithm for women treated for gynaecological cancer with long-term gastrointestinal consequences which aimed to evaluate the gastrointestinal symptoms of people previously treated for gynaecological cancer and to review whether the established treatment algorithm could be amended to optimise outcomes for these patients. Patients did indeed benefit from the intervention by reducing gastrointestinal symptom burden and improving quality of life. An estimated 3,225 women need access to this kind of service in the UK every year.
The paper Bowel dysfunction in survivors of gynaecologic malignancies assesses the prevalence of bowel dysfunction and the impact on quality of life. Over 200 women undergoing radiotherapy in Spain were sent questionnaires and over 40% of respondents reported bowel dysfunction. This study confirms the high prevalence of PRD symptoms following gynaecological cancer treatment.
A fascinating area of research is whether microbiota can be used to prevent gastrointestinal symptoms of PRD from developing. An article from a French research group entitled Prophylactic Faecalibacterium prausnitzii treatment prevents the acute breakdown of colonic epithelial barrier in a preclinical model of pelvic radiation disease offers promise of a rationale for using probiotics in the treatment or prevention of gastrointestinal consequences of radiotherapy treatment. Although there are few trials ongoing in this area, no definitive strain of bacteria has either been identified or recommended for use in PRD patients. Perhaps next time Research News could do a feature on the status of the literature on this topic – all suggestions of papers welcome, please send to firstname.lastname@example.org .
Radiation-induced Lumbosacral plexopathy (RILP)
The articles noted above show that gastrointestinal component of PRD attract more research than other PRD symptoms, such as those caused by nerve damage. A reader got in touch with a publication from an Italian team: Lumbosacral Plexopathy in Pelvic Radiotherapy: An Association not to be Neglected; A Systematic Review. Radiation-Induced Lumbosacral Plexopathy (RILP) is relatively rare but can have devastating effects on a patient’s quality of life. The article states that more attention is needed to contouring the field of radiation to avoid damage to the lumbar plexus – indeed the area is not generally regarded as an organ at “risk” from radiation toxicity. PRDA has a vital role in giving voice to the many serious problems that people with PRD have to live with, but we then rely on the medical and research establishment to pick up issues, such as nerve damage, and give them due attention.
To help PRDA raise more awareness, we welcome more views from patients who live with any form of radiation induced nerve damage. Many thanks to our reader for highlighting the above article. It is only by your efforts that everyone can become more aware of multiple issues surrounding PRD.
I hope you have enjoyed this second edition of Research News. We welcome all feedback, guest bloggers, suggestions for publications and links to study websites on PRD research.
Modified: 26th February 2021