Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Dec 10, 2015; 6(6): 272-280
Published online Dec 10, 2015. doi: 10.5306/wjco.v6.i6.272
Pelvic radiation disease: Updates on treatment options
Leonardo Frazzoni, Marina La Marca, Alessandra Guido, Alessio Giuseppe Morganti, Franco Bazzoli, Lorenzo Fuccio
Leonardo Frazzoni, Marina La Marca, Franco Bazzoli, Lorenzo Fuccio, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
Alessandra Guido, Alessio Giuseppe Morganti, Division of Radiation Oncologym S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
Author contributions: All the authors equally contributed to the paper and approved the current version of the article.
Conflict-of-interest statement: All the authors declare not to have any conflict of interest.
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:
Correspondence to: Lorenzo Fuccio, MD, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Telephone: +39-51-2143338
Received: July 3, 2015
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.

Keywords: Pelvic radiation disease, Radiation-induced proctopathy, Radiotherapy, Gastrointestinal toxicity, Sucralfate, Metronidazole, Probiotics, Argon plasma coagulation, Hyperbaric oxygen, Formalin

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.