Published online Dec 10, 2015. doi: 10.5306/wjco.v6.i6.272
Peer-review started: July 5, 2015
First decision: July 31, 2015
Revised: September 18, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: December 10, 2015
Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments.
Core tip: Radiotherapy is frequently employed as part of the multimodal treatment of pelvic cancers. Despite recent advances in irradiation techniques, acute and late- onset radiation-induced gastrointestinal toxicity, also known as pelvic radiation disease, is still being frequently reported. This review provides an up-to-date summary on medical and endoscopic approaches that have been evaluated with treating intent, focusing on the best available evidence, primarily randomized controlled studies.