Abstract
A systematic review and meta-analysis were designed to evaluate the efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer. We searched the Cochrane Library, PubMed, EMBASE and Web of Science up to November 2015. We also hand searched the citation lists of included studies and previously identified systematic reviews to identify further relevant trials. Odds ratio (OR) was used to compare efficacy, and the pooled OR was estimated using a random effects model; heterogeneity was assessed with Cochran’s Q and the Higgins’ I2-test. Two reviewers assessed trial quality and extracted data independently. Analysis and bias for each included study were performed using Review Manager 5.2. Nine randomized and placebo-controlled studies (N=1265 participants) were included for assessing efficacy, of which seven were about radiotherapy and two about chemotherapy. Probiotic groups were compared with control groups with respect to the the incidence of diarrhea, OR=0.47 (95% confidence interval 0.28–0.76; P=0.002). Eleven studies, including 1612 people (873 consuming probiotics and 739 not consuming probiotics), were used for the analysis of safety of probiotics. Of the 11 studies, seven studies had no adverse events (AEs) caused by probiotics, whereas four studies reported varying degrees of AEs in their treatment. Probiotics may have a beneficial effect in prevention of chemoradiotherapy-induced diarrhea generally, especially for Grade⩾2 diarrhea. Probiotics may rarely cause AEs.
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References
Fuller R . Probiotics in man and animals. J Appl Bacteriol 1989; 66: 65–378.
West CM, Davidson SE . Measurement tools for gastrointestinal symptoms in radiation oncology. Curr Opin Support Palliat Care 2009; 3: 36–40.
Andreyev J . Gastrointestinal complications of pelvic radiotherapy: are they of any importance? Gut 2005; 54: 1051–1054.
Hauer-Jensen M, Wang J, Denham JW . Bowel injury: current and evolving management strategies. Semin Radiat Oncol 2003; 13: 357–371.
Osterlund P, Ruotsalainen T, Korpela R, Saxelin M, Ollus A, Valta P et al. Lactobacillus supplementation for diarrhoea related to chemotherapy of colorectal cancer: a randomised study. Br J Cancer 2007; 97: 1028–1034.
Takasuna K, Hagiwara T, Watanabe K, Onose S, Yoshida S, Kumazawa E et al. Optimal antidiarrhea treatment for antitumor agent irinotecan hydrochloride (CPT-11) -induced delayed diarrhea. Cancer Chemother Pharmacol 2006; 58: 494–503.
Arbuckle RB, Huber SL, Zacker C . The consequences of diarrhea occurring during chemotherapy for colorectal cancer: a retrospective study. Oncologist 2000; 5: 250–259.
Dranitsaris G, Maroun J, Shah A . Estimating the cost of illness in colorectal cancer patients who were hospitalized for severe chemotherapy-induced diarrhea. Can J Gastroenterol 2005; 19: 83–87.
Salminen E, Elomaa I, Minkkinen J, Vapaatalo H, Salminen S . Preservation of intestinal integrity during radiotherapy using live Lactobacillus acidophilus cultures. Clin Radiol 1988; 39: 435–437.
Bounous G . The use of elemental diets during cancer therapy (review). Anticancer Res 1983; 3: 299–304.
Miller AC, Elamin EM . Use of probiotics for treatment of chemotherapy-induced diarrhea: is it a myth? JPEN J Parenter Enteral Nutr 2009; 33: 573–574.
Guarner F, Malagelada JR . Role of bacteria in experimental colitis. Best Pract Res Clin Gastroenterol 2003; 17: 793–804.
Hooper LV, Gordon JI . Commensal host-bacterial relationships in the gut. Science 2001; 292: 1115–1118.
Mego M, Chovanec J, Vochyanova-Andrezalova I, Konkolovsky P, Mikulova M, Reckova M et al. Prevention of irinotecan induced diarrhea by probiotics: A randomized double blind, placebo controlled pilot study. Complement Ther Med 2015; 23: 356–362.
Demers M, Dagnault A, Desjardins J . A randomized double-blind controlled trial: impact of probiotics on diarrhea in patients treated with pelvic radiation. Clin Nutr 2014; 33: 761–767.
Timko J . Probiotics as prevention of radiation-induced diarrhoea. J Radiother Pract 2010; 9: 201–208.
Chitapanarux I, Chitapanarux T, Traisathit P, Kudumpee S, Tharavichitkul E, Lorvidhaya V . Randomized controlled trial of live lactobacillus acidophilus plus bifidobacterium bifidum in prophylaxis of diarrhea during radiotherapy in cervical cancer patients. Radiat Oncol 2010; 5: 31.
Castro MG, Glasberg SP, Horie LM, Waitzberg DL . Effects of probiotic in prevention of radiation-induced diarrhea. Clin Nutr Suppl 2009; 4: 72–73.
Giralt J, Regadera JP, Verges R, Romero J, de la Fuente I, Biete A et al. Effects of probiotic Lactobacillus casei DN-114 001 in prevention of radiation-induced diarrhea: Results from multicenter, randomized, placebo-controlled nutritional trial. Int J Radiat Oncol Biol Phys 2008; 71: 1213–1219.
Delia P, Sansotta G, Donato V, Frosina P, Messina G, De Renzis C et al. Use of probiotics for prevention of radiation-induced diarrhea. World J Gastroenterol 2007; 13: 912–915.
Okawa T, Niibe H, Arai T, Sekiba K, Noda K, Takehi S et al. Effect of LC9018 combined with radiation therapy on carcinoma of the uterine cervix – a phase-III, multicenter, randomized, controlled-study. Cancer 1993; 72: 1949–1954.
Redman MG, Ward EJ, Phillips RS . The efficacy and safety of probiotics in people with cancer: a systematic review. Ann Oncol 2014; 25: 1919–1929.
Hamad A, Fragkos KC, Forbes A . A systematic review and meta-analysis of probiotics for the management of radiation induced bowel disease. Clin Nutr 2013; 32: 353–360.
National Cancer Institute: Common Terminology Criteria for Adverse Events, Version 4.0.; 2010. Available at: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf (accessed on 15 April 2014).
Higgins JPT, Green S (eds) Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 (updated March 2011). The Cochrane Collaboration. 2011. www.cochrane-handbook.org (accessed on 18 March 2014).
Moher D, Liberati A, Tetzlaff J, Altman DG . PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151: 264–269.
Review Manager (RevMan) (Computer Program). Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Centre for Reviews and Dissemination, University of York Systematic Reviews: CRD’s Guidance for Undertaking Reviews in Health Care. CRD, University of York: : York, UK, 2009.
Lee JY, Chu SH, Jeon JY, Lee MK, Park JH, Lee DC et al. Effects of 12 weeks of probiotic supplementation on quality of life in colorectal cancer survivors: a double-blind, randomized, placebo-controlled trial. Dig Liver Dis 2014; 46: 1126–1132.
Urbancsek H, Kazar T, Mezes I, Neumann K . Results of a double-blind, randomized study to evaluate the efficacy and safety of Antibiophilus (R) in patients with radiation-induced diarrhoea. Eur J Gastroenterol Hepatol 2001; 13: 391–396.
Henriksson R, Franzen L, Sandstrom K, Nordin A, Arevarn M, Grahn E . Effects of active addition of bacterial cultures in fermented milk to patients with chronic bowel discomfort following irradiation. Support Care Cancer 1995; 3: 81–83.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097.
Delia P, Sansotta G, Donato V, Messina G, Frosina P, Pergolizzi S 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.
Loke YK, Price D, Herxheimer A . Systematic reviews of adverse effects: framework for a structured approach. BMC Med Res Methodol 2007; 7: 32.
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K-KW and LJ contributed to the study design, data analysis and quality assessment; Z-XW, Jian-meng Zhao and CXP contributed to the literature search; SH, Jun Wang and NY contributed to the manuscript writing.
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Wang, YH., Yao, N., Wei, KK. et al. The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: a systematic review and meta-analysis. Eur J Clin Nutr 70, 1246–1253 (2016). https://doi.org/10.1038/ejcn.2016.102
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DOI: https://doi.org/10.1038/ejcn.2016.102
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