School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia; Department of Nutrition and Dietetics, The Royal Brisbane Women's Hospital, Herston, Queensland, Australia.
School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia; Department of Nutrition and Dietetics, The Royal Brisbane Women's Hospital, Herston, Queensland, Australia.
J Acad Nutr Diet. 2021 Feb;121(2):261-277.e2. doi: 10.1016/j.jand.2020.08.077. Epub 2020 Oct 28.
Pelvic radiotherapy is a common part of treatment used in gynecologic malignancies. The side effects associated with treatment, such as gastrointestinal toxicity, can be acute and chronic. Previous studies have provided little clarity in regard to the best dietary intervention for management of symptoms.
The aim of this systematic review was to summarize the evidence on the efficacy of nutrition interventions involving fiber modification in patients with gynecologic cancers undergoing pelvic radiotherapy to prevent or alleviate gastrointestinal side effects, in comparison to standard care, placebo, or no intervention.
Studies, inclusive of any language and date, up to December 1, 2019, were selected from eight electronic databases: PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, Scopus, Science direct, Clinical Key, Web of Science, and Cochrane. Key study outcomes included gastrointestinal toxicity such as diarrhea/bowel changes, abdominal pain or bloating, and nausea; nutritional status; and quality of life. All studies underwent a quality appraisal using the Academy of Nutrition and Dietetics Quality Criteria Checklist and certainty of evidence was assessed via the Grading of Recommendations Assessment, Development, and Evaluation criteria.
Four studies were included (total number of participants = 89), with quality ratings of neutral or negative. Due to the risk of bias, inconsistency, indirectness, and imprecision, there was very low certainty of evidence that dietary fiber modifications improved these outcomes. Some positive trends regarding improvements in incidence and severity of diarrhea and bowel symptoms were reported; however, the body of evidence was insufficient to form specific recommendations for clinical practice. This is reflected in the Grading of Recommendations Assessment, Development, and Evaluation criteria rating (very low level of certainty) for quality of life and gastrointestinal toxicity outcomes.
This systematic review suggests that supplementary fiber modification during radiation therapy may have some potential benefits with improving gastrointestinal symptoms; however, more definitive evidence and further exploration of fiber in a therapeutic role is required to inform dietary practice.
盆腔放疗是妇科恶性肿瘤治疗的常见组成部分。与治疗相关的副作用，如胃肠道毒性，可能是急性和慢性的。先前的研究在针对症状管理的最佳饮食干预方面提供的信息有限。
本系统评价的目的是总结关于纤维修饰营养干预在接受盆腔放疗的妇科癌症患者中预防或缓解胃肠道副作用的疗效证据，与标准护理、安慰剂或无干预相比。
从 8 个电子数据库（PubMed、Embase、护理学和联合健康文献累积索引、Scopus、Science direct、Clinical Key、Web of Science 和 Cochrane）中选择了截至 2019 年 12 月 1 日的所有语言和日期的研究。主要研究结果包括腹泻/肠道变化、腹痛或腹胀和恶心等胃肠道毒性；营养状况；以及生活质量。所有研究均使用营养与饮食学会质量标准检查表进行质量评估，并使用推荐评估、制定和评估标准评估证据确定性。
共纳入 4 项研究（总参与者人数=89 人），质量评分为中性或负面。由于存在偏倚风险、不一致性、间接性和不精确性，非常低确定性证据表明膳食纤维修改可改善这些结果。有一些关于改善腹泻和肠道症状发生率和严重程度的积极趋势的报道；然而，证据不足，无法为临床实践形成具体建议。这反映在推荐评估、制定和评估标准（非常低的确定性水平）对生活质量和胃肠道毒性结果的评级中。
本系统评价表明，在放疗期间补充纤维修饰可能对改善胃肠道症状有一定的益处；然而，需要更明确的证据和进一步探索纤维的治疗作用，以指导饮食实践。
