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Nick Johnson - One of the best experts on this subject based on the ideXlab platform.
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vaginal dilator therapy for women receiving Pelvic Radiotherapy
Cochrane Database of Systematic Reviews, 2014Co-Authors: Tracie Miles, Nick JohnsonAbstract:Background Many vaginal dilator therapy guidelines advocate routine vaginal dilation during and after Pelvic Radiotherapy to prevent stenosis (abnormal narrowing of the vagina). The UK Gynaecological Oncology Nurse Forum recommend dilation “three times weekly for an indefinite time period”. The UK patient charity Cancer Backup advises using vaginal dilators from two to eight weeks after the end of Radiotherapy treatment. Australian guidelines recommend dilation after brachytherapy “as soon as is comfortably possible” and “certainly within four weeks and to continue for three years or indefinitely if possible”. However, dilation is intrusive, uses health resources and can be psychologically distressing. It has also caused rare but very serious damage to the rectum.
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The Cochrane Library - Vaginal dilator therapy for women receiving Pelvic Radiotherapy
Cochrane Database of Systematic Reviews, 2010Co-Authors: Tracie Miles, Nick JohnsonAbstract:Background Many vaginal dilator therapy guidelines advocate routine vaginal dilation during and after Pelvic Radiotherapy to prevent stenosis (abnormal narrowing of the vagina). The UK Gynaecological Oncology Nurse Forum recommend dilation “three times weekly for an indefinite time period”. The UK patient charity Cancer Backup advises using vaginal dilators from two to eight weeks after the end of Radiotherapy treatment. Australian guidelines recommend dilation after brachytherapy “as soon as is comfortably possible” and “certainly within four weeks and to continue for three years or indefinitely if possible”. However, dilation is intrusive, uses health resources and can be psychologically distressing. It has also caused rare but very serious damage to the rectum.
H. J. N. Andreyev - One of the best experts on this subject based on the ideXlab platform.
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Gastrointestinal symptoms after Pelvic Radiotherapy: a national survey of gastroenterologists.
Supportive Care in Cancer, 2011Co-Authors: Caroline C Henson, Susan E Davidson, A Lalji, R P Symonds, Ric Swindell, H. J. N. AndreyevAbstract:Purpose Seventeen thousand patients receive treatment with radical Pelvic Radiotherapy annually in the UK. Up to 50% develop significant gastrointestinal symptoms. The National Cancer Survivorship Initiative has identified access to specialist medical care for those with complications after cancer as one of their four key needs. We aimed to determine the current practice of British gastroenterologists with regards to chronic gastrointestinal symptoms after Pelvic Radiotherapy.
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Late onset bowel dysfunction after Pelvic Radiotherapy: a national survey of current practice and opinions of clinical oncologists
Clinical Oncology, 2011Co-Authors: Caroline C Henson, H. J. N. Andreyev, R P Symonds, Ric Swindell, D.n.y. Peel, Susan E DavidsonAbstract:Introduction 17,000 patients receive treatment with radical Pelvic Radiotherapy annually in the UK. Up to 50% of patients will develop bowel symptoms which affect quality of life. Services for this patient group are underdeveloped. Barriers to good clinical care include poor patient reporting, poor clinician recognition and a lack of established routes of referral. The National Cancer Survivorship Initiative (2007) has identified access to specialist medical care for those with complications that occur after cancer as one of the four key needs of cancer survivors. It is in this context that we aimed to determine the current practice of clinical oncologists in the UK. Methods A questionnaire was developed and sent to the 314 clinical oncologists in the UK who treat Pelvic malignancies up to a maximum of three times by post. Results 190 (61%) responses were received. 76% of oncologists screen for GI dysfunction after Pelvic Radiotherapy. 85% screen for symptoms through history taking with only 11% using formal screening questionnaires. Clinical oncologists view toxicity as a significant problem, with 64% estimating that up to 24% patients have bowel symptoms at 1 year. 71% oncologists refer Conclusion Whilst British oncologists recognise bowel dysfunction after Pelvic Radiotherapy as a significant problem, they refer only a minority of patients for specialist evaluation. This may reflect the lack of clear routes of referral and access to GI expertise. The estimated proportion of patients affected was lower than that reported in the literature, which may reflect the lack of robust systems in routine practice to detect significant symptoms. The views expressed clearly highlight the need for a dedicated gastroenterology-lead multidisciplinary service to address the imbalance between this established unmet need and current service provision.
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small bowel bacterial overgrowth and lactose intolerance during radical Pelvic Radiotherapy an observational study
European Journal of Cancer, 2008Co-Authors: L Wedlake, Karen Thomas, C Mcgough, H. J. N. AndreyevAbstract:Abstract Introduction Loose stool affects up to 80% of all patients during Pelvic Radiotherapy and faecal incontinence may occur. Several causes for diarrhoea have been defined, though few oncologists target these causes in affected patients and most treat symptomatically only. It is not known whether small bowel bacterial overgrowth, a frequent cause of gastrointestinal symptoms in other contexts, occurs during Radiotherapy. The frequency of new-onset lactose intolerance during Pelvic Radiotherapy is also not clear. Aims and methods To perform an observational pilot study to estimate the incidence of small bowel bacterial overgrowth and lactose intolerance during radical Pelvic Radiotherapy. Before treatment started and at weeks 4–5 of Pelvic Radiotherapy, a glucose hydrogen breath test and lactose tolerance test were performed. Gastrointestinal symptoms were assessed using the Vaizey incontinence questionnaire and the Radiation Therapy Oncology Group scoring system. Results Twenty two men and 17 women (median age 61, range 42–81) were recruited, four were treated for gastrointestinal, 17 were treated for gynaecological and 18 for urological cancers. Thirty-eight patients underwent glucose hydrogen breath tests and 26 patients underwent lactose breath tests at both time points. Ten patients (26%) were positive for the glucose hydrogen breath test: 60% of these developed new or worsening faecal incontinence during treatment and 60% had worsening bowel frequency. Four patients (15%) developed lactose intolerance. Of these 1 developed worsening faecal incontinence during treatment, 2 (50%) developed new-onset increase in bowel frequency or a change in the quality of bowel habit. Conclusion Small bowel bacterial overgrowth and lactose intolerance may occur during radical Pelvic Radiotherapy and are likely to contribute to gastrointestinal symptoms in some patients.
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Is supplementation with elemental diet feasible in patients undergoing Pelvic Radiotherapy
Clinical Nutrition, 2006Co-Authors: C Mcgough, Kevin J. Harrington, Christine Baldwin, Gary Frost, A. Norman, P. Blake, D. Tait, V. Khoo, H. J. N. AndreyevAbstract:Summary Background Acute gastrointestinal upset occurs in approximately 80% of patients undergoing Radiotherapy for Pelvic cancers. Underlying changes relate to denudation of the mucosal layer which renders the small intestine vulnerable to additional damage from proteolytic enzymes and bile acids. Severe acute bowel symptoms may predispose to progressive fibrotic and ischaemic changes. Elemental diet given during treatment may reduce acute and chronic bowel symptoms induced by Pelvic Radiotherapy. Methods This study aimed to assess compliance with elemental diet during Pelvic Radiotherapy. Patients with gynaecological, urological or rectal malignancy undergoing radical or adjuvant Pelvic Radiotherapy were randomised to one of five groups. Each group was assigned a target quantity of three different elemental sip feeds (Group 1, 20%, Group 2, 50%, Group 3, 75% of calorie requirements taken as E028 extra liquid; Group 4, 50% of calorie requirements taken as E028 extra powder; Group 5, 50% of calorie requirements taken as Emsogen powder). Compliance was assessed using a diary card and weekly assessment. Statistical analyses were conducted on an intention to treat basis. Results Fifty patients (44 female, six male) mean age 58 yr (95% CI 55–61), were recruited to the study (24 endometrial, 17 cervical, 7 rectal, 1 vulval and 1 bladder carcinoma). Mean weight at baseline was 74.5 kg (95% CI 69–80) and this did not change during treatment. Full compliance was achieved in three patients, all from Group 1. By week 5, only 46% of patients were consuming elemental diet. Post hoc analysis of variance with repeated measures indicated that there were no significant differences in volume of elemental diet consumed between groups ( P = 0.937 ). There was a significant inverse linear relationship between intake of elemental diet and time ( P 0.001 ). Conclusions Different formulations of elemental diet do not influence compliance. Patients are unlikely to be able to consume more than one-third of their calorie requirements in the form of an elemental sip feed. Further investigation is warranted to determine if intervention with this volume of elemental diet is beneficial.
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The significance of rectal bleeding after Pelvic Radiotherapy
Alimentary Pharmacology and Therapeutics, 2005Co-Authors: H. R. T. Williams, P. Vlavianos, Peter Blake, David P. Dearnaley, Diana Tait, H. J. N. AndreyevAbstract:The significance of rectal bleeding after Pelvic Radiotherapy Background: Rectal bleeding after Pelvic Radiotherapy is often attributed to radiation proctitis and patients do not routinely undergo flexible endoscopy. Aims: To assess the significance of bleeding after Radiotherapy. Methods: We maintained a prospective register of all such patients referred to our endoscopy unit. Results: One hundred and thirty-nine men (median age 70 years; range 31-82), and 32 women (median age 61 years; range 30-81) were referred with rectal bleeding (median 2 years; range 0-21) after Pelvic Radiotherapy. Primary tumour sites were urological (n = 139), gastrointestinal (n = 7) and gynaecological (n = 25). Ninety patients had bleeding alone; 81 had other symptoms. One hundred and forty-one had typical radiation proctitis; in 65 this was the sole diagnosis; eight had cancer, nine had high-risk adenomas, and six had three or more small adenomas. Ninety-five other diagnoses were made. Eleven (73%) patients with advanced polyps or cancer required only flexible sigmoidoscopy to make the diagnosis, while four (27%) diagnoses were made only after colonoscopy; 47% of these patients had no other symptoms apart from rectal bleeding. Conclusions: After Pelvic Radiotherapy, clinical symptoms are not reliable in differentiating between radiation proctitis alone or more significant pathology. It is mandatory that all patients with new onset rectal bleeding are investigated with, at least, flexible sigmoidoscopy.
Tracie Miles - One of the best experts on this subject based on the ideXlab platform.
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vaginal dilator therapy for women receiving Pelvic Radiotherapy
Cochrane Database of Systematic Reviews, 2014Co-Authors: Tracie Miles, Nick JohnsonAbstract:Background Many vaginal dilator therapy guidelines advocate routine vaginal dilation during and after Pelvic Radiotherapy to prevent stenosis (abnormal narrowing of the vagina). The UK Gynaecological Oncology Nurse Forum recommend dilation “three times weekly for an indefinite time period”. The UK patient charity Cancer Backup advises using vaginal dilators from two to eight weeks after the end of Radiotherapy treatment. Australian guidelines recommend dilation after brachytherapy “as soon as is comfortably possible” and “certainly within four weeks and to continue for three years or indefinitely if possible”. However, dilation is intrusive, uses health resources and can be psychologically distressing. It has also caused rare but very serious damage to the rectum.
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The Cochrane Library - Vaginal dilator therapy for women receiving Pelvic Radiotherapy
Cochrane Database of Systematic Reviews, 2010Co-Authors: Tracie Miles, Nick JohnsonAbstract:Background Many vaginal dilator therapy guidelines advocate routine vaginal dilation during and after Pelvic Radiotherapy to prevent stenosis (abnormal narrowing of the vagina). The UK Gynaecological Oncology Nurse Forum recommend dilation “three times weekly for an indefinite time period”. The UK patient charity Cancer Backup advises using vaginal dilators from two to eight weeks after the end of Radiotherapy treatment. Australian guidelines recommend dilation after brachytherapy “as soon as is comfortably possible” and “certainly within four weeks and to continue for three years or indefinitely if possible”. However, dilation is intrusive, uses health resources and can be psychologically distressing. It has also caused rare but very serious damage to the rectum.
Marianne Grønlie Guren - One of the best experts on this subject based on the ideXlab platform.
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palliative Pelvic Radiotherapy for symptomatic rectal cancer a prospective multicenter study
Acta Oncologica, 2016Co-Authors: Marte Grønlie Cameron, Christian Kersten, Sophie D. Fosså, Ingvild Vistad, Rene Van Helvoirt, Kjetil Weyde, Eva Skovlund, Christine Undseth, Ingvil Mjaaland, Marianne Grønlie GurenAbstract:AbstractBackground and purpose: Palliative Pelvic Radiotherapy (PPRT) is used to treat locally advanced rectal cancer (RC) although symptomatic effects and toxicities are poorly documented. Aims were to evaluate symptom severity, quality of life (QOL) and toxicity after PPRT.Material and methods: Fifty-one patients with symptomatic primary or recurrent RC prescribed PPRT with fractions of 3 Gy to 30–39 Gy were included. Primary outcome was severity of target symptoms (TS) 12 weeks after PPRT. Pelvic symptom burden, toxicity, and QOL were assessed. Response was defined as patient-reported TS improvement or resolution.Results: Pain (n = 24), rectal dysfunction (n = 16), and hematochezia (n = 9) were the most common TSs. Overall response rate among evaluable patients 12 weeks after PPRT was 28/33 (85%). Eighteen patients did not complete the study follow-up, 16 due to deteriorating health. TS responses were 10/13 (77%) for pain, 9/10 (90%) for rectal dysfunction, and 8/8 for hematochezia. Non-target Pelvic s...
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Palliative Pelvic Radiotherapy for symptomatic incurable prostate cancer.
Journal of Clinical Oncology, 2014Co-Authors: Marte Grønlie Cameron, Christian Kersten, Sophie D. Fosså, Ingvild Vistad, Rene Van Helvoirt, Kjetil Weyde, Eva Skovlund, Marianne Grønlie GurenAbstract:e16050 Background: External beam Radiotherapy is frequently used to treat Pelvic symptoms of castration resistant prostate cancer (CRPC). Documentation of palliative effect, toxicity and recommended treatment schedule are lacking. The aims of the study were to evaluate changes in symptom severity and degree of toxicity among patients with CRPC following palliative Pelvic Radiotherapy (PPRT). Methods: Patients with CRPC and a symptomatic Pelvic mass that were prescribed PPRT in 3 Gy fractions to 30-39 Gy were prospectively included. Patient-reported symptoms were assessed before, at the end of, and 6 and 12 wks after PPRT. Results: Of 46 patients included, 39 were evaluable. Median age was 79 yrs (67 – 93). Treatment volume included primary tumor in 45 patients and lymph node metastases in 10. Treatment was given as conformal 3D PPRT in 44 patients. Urinary obstruction, macroscopic hematuria, and Pelvic pain were the most common target symptoms (TS) identified by patients. In 69% of evaluable patients, the...
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Palliative Pelvic Radiotherapy of symptomatic incurable prostate cancer - A systematic review
Radiotherapy and Oncology, 2014Co-Authors: Marte Grønlie Cameron, Christian Kersten, Marianne Grønlie Guren, Sophie D. Fosså, Ingvild VistadAbstract:Background and purpose: Patients with prostate cancer (PC) and a symptomatic Pelvic tumor may be treated with palliative Pelvic Radiotherapy for symptom relief or to delay symptom progression. Radiotherapy dose and fractionation regimens vary. We aimed to provide an overview of the literature and to evaluate palliative Pelvic Radiotherapy of PC focusing on symptomatic effect, quality of life (QOL), and toxicity, and to determine the optimal Radiotherapy schedule. Material and methods: Systematic literature searches of Medline, Embase and Cochrane databases were performed through 2011. Studies reporting symptom and QOL responses were eligible. Results: Nine studies were included, all retrospective chart reviews. There were large variations in Radiotherapy dose and fractionation. Overall symptom response rate was 75% and positive responses were reported for hemorrhage (73%), pain (80%), bladder outlet obstruction (63%), rectal symptoms (78%) and ureteric obstruction (62%). Toxicity results were not evaluable. Conclusions: Despite limitations in the review process and the included studies, we conclude that Pelvic Radiotherapy for symptomatic PC appears to provide effective palliation of a variety of symptoms. There is currently no valid documentation regarding onset or duration of palliation. No recommendations can be provided regarding target dose or fractionation schedule in this context.
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Palliative Pelvic Radiotherapy of symptomatic incurable rectal cancer - a systematic review.
Acta Oncologica, 2013Co-Authors: Marte Grønlie Cameron, Christian Kersten, Sophie D. Fosså, Ingvild Vistad, Marianne Grønlie GurenAbstract:AbstractBackground. Locally advanced and recurrent rectal cancers frequently cause Pelvic morbidity including pain, bleeding and mass effect. Palliative Pelvic Radiotherapy is used to relieve these symptoms and delay local progression. There is no established optimal Radiotherapy regimen and clinical practices vary. Our aim was to review the efficacy and toxicity of palliative Pelvic Radiotherapy of symptomatic rectal cancer and to evaluate different fractionation schedules, based on published literature. Material and methods. Systematic literature searches of Medline, Embase and Cochrane databases were performed through 2011. Studies reporting symptomatic response or quality of life (QOL) after palliative Radiotherapy for rectal or rectosigmoid cancer were eligible. Results. Twenty-seven studies were included, of which 23 were retrospective reviews. There were no patient-reported outcomes or QOL assessments. There were large variations in applied Radiotherapy regimens. Pooled overall symptom response rat...
Marte Grønlie Cameron - One of the best experts on this subject based on the ideXlab platform.
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palliative Pelvic Radiotherapy for symptomatic rectal cancer a prospective multicenter study
Acta Oncologica, 2016Co-Authors: Marte Grønlie Cameron, Christian Kersten, Sophie D. Fosså, Ingvild Vistad, Rene Van Helvoirt, Kjetil Weyde, Eva Skovlund, Christine Undseth, Ingvil Mjaaland, Marianne Grønlie GurenAbstract:AbstractBackground and purpose: Palliative Pelvic Radiotherapy (PPRT) is used to treat locally advanced rectal cancer (RC) although symptomatic effects and toxicities are poorly documented. Aims were to evaluate symptom severity, quality of life (QOL) and toxicity after PPRT.Material and methods: Fifty-one patients with symptomatic primary or recurrent RC prescribed PPRT with fractions of 3 Gy to 30–39 Gy were included. Primary outcome was severity of target symptoms (TS) 12 weeks after PPRT. Pelvic symptom burden, toxicity, and QOL were assessed. Response was defined as patient-reported TS improvement or resolution.Results: Pain (n = 24), rectal dysfunction (n = 16), and hematochezia (n = 9) were the most common TSs. Overall response rate among evaluable patients 12 weeks after PPRT was 28/33 (85%). Eighteen patients did not complete the study follow-up, 16 due to deteriorating health. TS responses were 10/13 (77%) for pain, 9/10 (90%) for rectal dysfunction, and 8/8 for hematochezia. Non-target Pelvic s...
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Palliative Pelvic Radiotherapy for symptomatic incurable prostate cancer.
Journal of Clinical Oncology, 2014Co-Authors: Marte Grønlie Cameron, Christian Kersten, Sophie D. Fosså, Ingvild Vistad, Rene Van Helvoirt, Kjetil Weyde, Eva Skovlund, Marianne Grønlie GurenAbstract:e16050 Background: External beam Radiotherapy is frequently used to treat Pelvic symptoms of castration resistant prostate cancer (CRPC). Documentation of palliative effect, toxicity and recommended treatment schedule are lacking. The aims of the study were to evaluate changes in symptom severity and degree of toxicity among patients with CRPC following palliative Pelvic Radiotherapy (PPRT). Methods: Patients with CRPC and a symptomatic Pelvic mass that were prescribed PPRT in 3 Gy fractions to 30-39 Gy were prospectively included. Patient-reported symptoms were assessed before, at the end of, and 6 and 12 wks after PPRT. Results: Of 46 patients included, 39 were evaluable. Median age was 79 yrs (67 – 93). Treatment volume included primary tumor in 45 patients and lymph node metastases in 10. Treatment was given as conformal 3D PPRT in 44 patients. Urinary obstruction, macroscopic hematuria, and Pelvic pain were the most common target symptoms (TS) identified by patients. In 69% of evaluable patients, the...
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Palliative Pelvic Radiotherapy of symptomatic incurable prostate cancer - A systematic review
Radiotherapy and Oncology, 2014Co-Authors: Marte Grønlie Cameron, Christian Kersten, Marianne Grønlie Guren, Sophie D. Fosså, Ingvild VistadAbstract:Background and purpose: Patients with prostate cancer (PC) and a symptomatic Pelvic tumor may be treated with palliative Pelvic Radiotherapy for symptom relief or to delay symptom progression. Radiotherapy dose and fractionation regimens vary. We aimed to provide an overview of the literature and to evaluate palliative Pelvic Radiotherapy of PC focusing on symptomatic effect, quality of life (QOL), and toxicity, and to determine the optimal Radiotherapy schedule. Material and methods: Systematic literature searches of Medline, Embase and Cochrane databases were performed through 2011. Studies reporting symptom and QOL responses were eligible. Results: Nine studies were included, all retrospective chart reviews. There were large variations in Radiotherapy dose and fractionation. Overall symptom response rate was 75% and positive responses were reported for hemorrhage (73%), pain (80%), bladder outlet obstruction (63%), rectal symptoms (78%) and ureteric obstruction (62%). Toxicity results were not evaluable. Conclusions: Despite limitations in the review process and the included studies, we conclude that Pelvic Radiotherapy for symptomatic PC appears to provide effective palliation of a variety of symptoms. There is currently no valid documentation regarding onset or duration of palliation. No recommendations can be provided regarding target dose or fractionation schedule in this context.
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Palliative Pelvic Radiotherapy of symptomatic incurable rectal cancer - a systematic review.
Acta Oncologica, 2013Co-Authors: Marte Grønlie Cameron, Christian Kersten, Sophie D. Fosså, Ingvild Vistad, Marianne Grønlie GurenAbstract:AbstractBackground. Locally advanced and recurrent rectal cancers frequently cause Pelvic morbidity including pain, bleeding and mass effect. Palliative Pelvic Radiotherapy is used to relieve these symptoms and delay local progression. There is no established optimal Radiotherapy regimen and clinical practices vary. Our aim was to review the efficacy and toxicity of palliative Pelvic Radiotherapy of symptomatic rectal cancer and to evaluate different fractionation schedules, based on published literature. Material and methods. Systematic literature searches of Medline, Embase and Cochrane databases were performed through 2011. Studies reporting symptomatic response or quality of life (QOL) after palliative Radiotherapy for rectal or rectosigmoid cancer were eligible. Results. Twenty-seven studies were included, of which 23 were retrospective reviews. There were no patient-reported outcomes or QOL assessments. There were large variations in applied Radiotherapy regimens. Pooled overall symptom response rat...