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World J Gastrointest Pharmacol Ther. Feb 6, 2015; 6(1): 1-9
Published online Feb 6, 2015. doi: 10.4292/wjgpt.v6.i1.1
Prevention of pelvic radiation disease
Lorenzo Fuccio, Leonardo Frazzoni, Alessandra Guido
Lorenzo Fuccio, Leonardo Frazzoni, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, 40136 Bologna, Italy.
Alessandra Guido, Division of Radiation Oncology, S.Orsola-Malpighi Hospital, University of Bologna, 40136 Bologna, Italy
Author contributions: All the authors equally contributed to the paper and approved the final version of the article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lorenzo Fuccio, MD, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40136 Bologna, Italy. lorenzofuccio@gmail.com
Telephone: +39-51-6363338 Fax: +39-51-6363338
Received: June 6, 2014
Peer-review started: June 8, 2014
First decision: July 10, 2014
Revised: September 2, 2014
Accepted: November 7, 2014
Article in press: November 10, 2014
Published online: February 6, 2015
Abstract

Pelvic cancers are among the most frequently diagnosed cancers worldwide. Treatment of patients requires a multidisciplinary approach that frequently includes radiotherapy. Gastrointestinal (GI) radiation-induced toxicity is a major complication and the transient or long-term problems, ranging from mild to very severe, arising in non-cancerous tissues resulting from radiation treatment to a tumor of pelvic origin, are actually called as pelvic radiation disease. The incidence of pelvic radiation disease changes according to the radiation technique, the length of follow up, the assessment method, the type and stage of cancer and several other variables. Notably, even with the most recent radiation techniques, i.e., intensity-modulated radiotherapy, the incidence of radiation-induced GI side effects is overall reduced but still not negligible. In addition, radiation-induced GI side effects can develop even after several decades; therefore, the improvement of patient life expectancy will unavoidably increase the risk of developing radiation-induced complications. Once developed, the management of pelvic radiation disease may be challenging. Therefore, the prevention of radiation-induced toxicity represents a reasonable way to avoid a dramatic drop of the quality of life of these patients. In the current manuscript we provide an updated and practical review on the best available evidences in the field of the prevention of pelvic radiation disease.

Keywords: Pelvic radiation disease, Radiotherapy, Gastrointestinal toxicity, Amifostine, Aminosalicylates, Sucralfate, Beclomethasone dipropionate, Probiotics supplementation, Misoprostol, Mesalazine

Core tip: Radiotherapy is a treatment of choice in the management of several pelvic cancers. Acute and late-onset radiation-induced gastrointestinal toxicity, also known as pelvic radiation disease, is still frequently observed, despite recent improvements in radiation techniques. In the current review we provide an updated overview on the medical therapies that have been investigated with preventive intents, focusing our attention on the best available evidences, primarily randomized controlled studies.