A systematic review of dose-volume predictors and constraints for late bowel toxicity following pelvic radiotherapy

Jadon, Rashmi, Higgins, Emma, Hanna, Louise, Evans, Mererid, Coles, Bernadette ORCID: https://orcid.org/0000-0003-0695-2865 and Staffurth, John ORCID: https://orcid.org/0000-0002-7834-3172 2019. A systematic review of dose-volume predictors and constraints for late bowel toxicity following pelvic radiotherapy. Radiation Oncology 14 (1) , -. 10.1186/s13014-019-1262-8

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Abstract

Background Advanced pelvic radiotherapy techniques aim to reduce late bowel toxicity which can severely impact the lives of pelvic cancer survivors. Although advanced techniques have been largely adopted worldwide, to achieve their aim, knowledge of which dose-volume parameters of which components of bowel predict late bowel toxicity is crucial to make best use of these techniques. The rectum is an extensively studied organ at risk (OAR), and dose-volume predictors of late toxicity for the rectum are established. However, for other components of bowel, there is a significant paucity of knowledge. The Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) reviews recommend dose-volume constraints for acute bowel toxicity for peritoneal cavity and bowel loops, although no constraints are recommended for late toxicity, despite its relevance to our increasing number of survivors. This systematic review aims to examine the published literature to seek dose-volume predictors and constraints of late bowel toxicity for OARs (apart from the rectum) for use in clinical practice. Methods A systematic literature search was performed using Medline, Embase, Cochrane Library, Web of Science, Cinahl and Pubmed. Studies were screened and included according to specific pre-defined criteria. Included studies were assessed for quality against QUANTEC-defined assessment criteria. Results 101 studies were screened to find 30 relevant studies. Eight studies related to whole bowel, 11 to small bowel, and 21 to large bowel (including 16 of the anal canal). The anal canal is an important OAR for the development of late toxicity, and we recommend an anal canal Dmean <40Gy as a constraint to reduce late incontinence. For other components of bowel (sigmoid, large bowel, intestinal cavity, bowel loops), although individual studies found statistically significant parameters and constraints these findings were not corroborated in other studies. Conclusions The anal canal is an important OAR for the development of late bowel toxicity symptoms. Further validation of the constraints found for other components of bowel is needed. Studies that were more conclusive included those with patient-reported data, where individual symptom scores were assessed rather than an overall score, and those that followed statistical and endpoint criteria as defined by QUANTEC.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	BioMed Central
ISSN:	1748-717X
Date of First Compliant Deposit:	6 June 2019
Date of Acceptance:	27 March 2019
Last Modified:	05 May 2023 03:22
URI:	https://orca.cardiff.ac.uk/id/eprint/123239

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