Biran Adam, Bolnykh Iakov, Rimmer Ben, Cunliffe Anthony, Durrant Lisa, Hancock John, Ludlow Helen, Pedley Ian, Rees Colin, Sharp Linda
Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK.
NHS Southwest London Clinical Commissioning Group, London SW19 1RH, UK.
Cancers (Basel). 2023 Aug 9;15(16):4037. doi: 10.3390/cancers15164037.
Pelvic radiotherapy can damage surrounding tissue and organs, causing chronic conditions including bowel symptoms. We systematically identified quantitative, population-based studies of patient-reported bowel symptoms following pelvic radiotherapy to synthesize evidence of symptom type, prevalence, and severity. Medline, CINAHL, EMBASE, and PsychINFO were searched from inception to September 2022. Following independent screening of titles, abstracts, and full-texts, population and study characteristics and symptom findings were extracted, and narrative synthesis was conducted. In total, 45 papers (prostate, = 39; gynecological, = 6) reporting 19 datasets were included. Studies were methodologically heterogeneous. Most frequently assessed was bowel function ('score', 26 papers, 'bother', 19 papers). Also assessed was urgency, diarrhea, bleeding, incontinence, abdominal pain, painful hemorrhoids, rectal wetness, constipation, mucous discharge, frequency, and gas. Prevalence ranged from 1% (bleeding) to 59% (anal bleeding for >12 months at any time since start of treatment). In total, 10 papers compared radiotherapy with non-cancer comparators and 24 with non-radiotherapy cancer patient groups. Symptom prevalence/severity was greater/worse in radiotherapy groups and symptoms more common/worse post-radiotherapy than pre-diagnosis/treatment. Symptom prevalence varied between studies and symptoms. This review confirms that many people experience chronic bowel symptoms following pelvic radiotherapy. Greater methodological consistency, and investigation of less-well-studied survivor populations, could better inform the provision of services and support.
盆腔放疗会损害周围组织和器官，引发包括肠道症状在内的慢性疾病。我们系统地检索了基于人群的、关于盆腔放疗后患者报告的肠道症状的定量研究，以综合症状类型、患病率和严重程度的证据。检索了Medline、CINAHL、EMBASE和PsychINFO数据库，时间跨度从建库至2022年9月。在对标题、摘要和全文进行独立筛选后，提取了人群和研究特征以及症状研究结果，并进行了叙述性综合分析。总共纳入了45篇论文（前列腺癌，n = 39；妇科癌症，n = 6），报告了19个数据集。研究在方法上存在异质性。最常评估的是肠道功能（“评分”，26篇论文；“困扰程度”，19篇论文）。还评估了尿急、腹泻、出血、失禁、腹痛、疼痛性痔疮、直肠潮湿、便秘、黏液排出、排便频率和气体。患病率从1%（出血）到59%（自治疗开始后任何时间出现超过12个月的肛门出血）不等。总共有10篇论文将放疗与非癌症对照人群进行了比较，24篇将放疗与非放疗癌症患者组进行了比较。放疗组的症状患病率/严重程度更高/更差，放疗后的症状比诊断/治疗前更常见/更严重。不同研究之间以及不同症状的症状患病率有所不同。本综述证实，许多人在盆腔放疗后会出现慢性肠道症状。更高的方法学一致性，以及对研究较少的幸存者群体进行调查，可为服务提供和支持提供更好的依据。
