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• W2015343274 abstract "Sir — In a recent issue of Clinical Oncology, Adams et al. [ [1] Adams E. Boulton M.G. Horney A. et al. The effects of pelvic radiotherapy on cancer survivors: symptom profile, psychological morbidity and quality of life. Clin Oncol. 2014; 26: 10-17 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar ] reported on 418 patients previously submitted to curative pelvic radiotherapy with the aim to investigate the patient-reported long-term toxicities. In particular, they observed a relatively high rate of gastrointestinal disturbances (i.e. bowel urgency, diarrhoea). The authors affirmed that patients may feel reluctant to discuss bowel symptoms with their doctor and this could justify the low referring rate to a gastroenterologist. In a recent published paper [ [2] Pergolizzi S. Maranzano E. De Angelis V. et al. Diarrhoea in irradiated patients: a prospective multicentre observational study. Dig Liver Dis. 2013; 45: 933-937 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar ], we reported on the incidence of diarrhoea in patients submitted to radiotherapy in an Italian multicentre study. We observed that anti-diarrhoea treatment was given in 56.2% of patients with diarrhoea and in the remaining 43.8% of cases no drug or dietary measures were given. These data seem to confirm the poor recognition of symptom diarrhoea among oncologists [ 1 Adams E. Boulton M.G. Horney A. et al. The effects of pelvic radiotherapy on cancer survivors: symptom profile, psychological morbidity and quality of life. Clin Oncol. 2014; 26: 10-17 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar , 3 Henson C.C. Andreyev H.J. Symonds R.P. Peel D. Swindell R. Davidson S.E. Late-onset bowel dysfunction after pelvic radiotherapy: a national survey of current practice and opinions of clinical oncologists. Clin Oncol. 2011; 23: 552-557 Abstract Full Text Full Text PDF Scopus (33) Google Scholar ]. This pattern of the low use of anti-diarrhoea drugs may be due to an underestimation of the clinical relevance of treatment-induced diarrhoea. It may be possible, however, that some of those patients did not declare the diarrhoea to the oncologist because their quality of life did not deteriorate. In that case, they did not need any specific measure. It is noteworthy that in both studies [ 1 Adams E. Boulton M.G. Horney A. et al. The effects of pelvic radiotherapy on cancer survivors: symptom profile, psychological morbidity and quality of life. Clin Oncol. 2014; 26: 10-17 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar , 2 Pergolizzi S. Maranzano E. De Angelis V. et al. Diarrhoea in irradiated patients: a prospective multicentre observational study. Dig Liver Dis. 2013; 45: 933-937 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar ], the scarce oncologists’ attention with respect to intestinal symptoms emerges. Do Adams et al. have data on the incidence of acute intestinal toxicities (during previous irradiation) among the patients studied? In fact, it seems that the severity of acute bowel toxicity may predetermine the degree of chronic bowel changes [ [4] Donaldson S. Jundt S. Ricour C. et al. Radiation enteritis in children. A retrospective review, clinicopathologic correlation and dietary management. Cancer. 1975; 35: 1167-1178 Crossref PubMed Scopus (116) Google Scholar ] but, to date, there is no demonstration that an early intervention to prevent or reduce acute toxicity [ 5 Delia P. Sansotta G. Donato V. et al. Prophylaxis of diarrhea in patients submitted to radiotherapeutic treatment on pelvic district: personal experience. Dig Liver Dis. 2002; 34: 584-586 Google Scholar , 6 Delia P. Sansotta G. Donato V. et al. Prevention of radiation-induced diarrhea with the use of VSL#3, a new high-potency probiotic preparation. Am J Gastroenterol. 2002; 97: 2150-2152 Crossref PubMed Google Scholar ] can reduce the incidence of late intestinal toxicities. We think it is important for the authors to comment on these issues and perhaps reply within the context of this journal." @default.
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• W2015343274 title "Diarrhoea and Pelvic Irradiation: A Neglected Issue" @default.
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• W2015343274 doi "https://doi.org/10.1016/j.clon.2014.05.010" @default.
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