1.Hoskin, P (editor) (2006) Radiotherapy in Practice. External Beam Therapy. Oxford, UK: Oxford University Press.
2.Ellis, H, Logan, BM & Dixon, AK (2001) Human Sectional Anatomy, 2nd ed. London: Hodder Arnold.
4.Khalid, U, McGough, C, Hackett, C et al. (2006) A modified inflammatory bowel disease questionnaire and the Vaizey incontinence questionnaire are more sensitive measures of acute gastrointestinal toxicity during pelvic radiotherapy than RTOG grading. Int J Radiat Oncol Biol Phys 64, 432–441.
5.Gami, B, Harrington, K, Blake, P et al. (2003) How patients manage gastrointestinal symptoms after pelvic radiotherapy. Aliment Pharmacol Ther 18, 987–994.
6.Olopade, F, Norman, A, Blake, P et al. (2005) A modified inflammatory bowel disease questionnaire and the Vaizey incontinence questionnaire are simple ways to identify patients with significant gastrointestinal symptoms after pelvic radiotherapy. Br J Cancer 9, 1663–1670.
7.Bergmark, K, Avall-Lundquist, E & Dickman, P (2002) Patient rating of distressful symptoms after treatment for early cervical cancer. Acta Obstet Gynecol Scand 81, 443–450.
8.al Abany, M, Helgason, A & Cronqvist, A (2002) Long-term symptoms after external beam radiation therapy for prostate cancer with three or four fields. Acta Oncol 41, 532–542.
9.Henningsohn, L, Wijkstrom, H & Dickman, D (2002) Distressful symptoms after radical radiotherapy for urinary bladder cancer. Radiother Oncol 62, 215–225.
10.Fokdal, L, Hoyer, M, Meldgaard, P et al. (2004) Long-term bladder, colorectal, and sexual functions after radical radiotherapy for urinary bladder cancer. Radiother Oncol 72, 139–145.
11.Crook, J, Esche, B, Futter, N et al. (1996) Effect of pelvic radiotherapy for prostate cancer on bowel, bladder, and sexual function: the patient's perspective. Urology 47, 387–394.
12.Wedlake, LJ & Andreyev, HJ (2011) Manipulating the consequential effect: an alternative approach to reducing pelvic radiation disease other than dose reduction. Curr Opin Support Palliat Care 5, 25–28.
13.Dorr, W & Hendry, JH (2001) Consequential late effects in normal tissues. Radiother Oncol 61, 223–231.
14.Denton, AS, Bond, SJ, Matthews, S et al. (2000) National audit of the management and outcome of carcinoma of the cervix treated with radiotherapy in 1993. Clin Oncol (R Coll Radiol) 12, 347–353.
15.Ooi, BS, Tjandra, JJ & Green, MD (1999) Morbidities of adjuvant chemotherapy and radiotherapy for resectable rectal cancer: an overview. Dis Colon Rectum 42, 403–418.
16.Eifel, PJ, Levenback, C, Wharton, JT et al. (1995) Time course and incidence of late complications in patients treated with radiation therapy for FIGO stage IB carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 32, 1289–1300.
17.Denham, JD & Hauer-Jensen, M (2002) The radiotherapeutic injury – a complex ‘wound’. Radiother Oncol 63, 129–145.
18.Hovdenak, N, Fajardo, LF & Hauer-Jensen, M (2000) Acute radiation proctitis: a sequential clinicopathologic study during pelvic radiotherapy. Int J Radiat Oncol Biol Phys 48, 1111–1117.
19.Larsen, A, Bjorge, B, Klementsen, B et al. (2007) Time patterns of changes in biomarkers, symptoms and histopathology during pelvic radiotherapy. Acta Oncol 46, 639–635.
20.Andreyev, HJ, Wotherspoon, A, Denham, JW et al. (2010) Defining pelvic-radiation disease for the survivorship era. Lancet Oncol 11, 310–312.
21.Bye, A, Kaasa, S, Ose, T et al. (1992) The influence of low fat, low lactose diet on diarrhoea during pelvic radiotherapy. Clin Nutr 11, 147–153.
22.Stryker, J, Mortel, R & Hepner, G (1978) The effect of pelvic irradiation on lactose absorption. Int J Radiat Oncol Biol Phys 4, 859–863.
23.Wedlake, L, Thomas, K, McGough, C et al. (2008) Small bowel bacterial overgrowth and lactose intolerance during radical pelvic radiotherapy: an observational study. Eur J Cancer 44, 2212–2217.
24.Andersson, H, Bosaeus, I & Nystrom, C (1978) Bile salt malabsorption in the radiation syndrome. Acta Radiol Oncol Radiat Phys Biol 17, 312–318.
25.Chary, S & Thompson, D (1984) A clinical trial evaluating cholestyramine to prevent diarrhea in patients maintained on low-fat diets during pelvic radiation therapy. Int J Radiat Oncol Biol Phys 10, 1885–1890.
26.Yeoh, EK, Horowitz, M, Russo, A et al. (1993) Effect of pelvic irradiation on gastrointestinal function. Am J Med 95, 397–406.
27.Husebye, E, Skar, V, Hoverstad, T et al. (1995) Abdominal intestinal motor patterns explain enteric colonization with Gram-negative bacilli in late radiation enteropathy. Gastroenterology 109, 1078–1089.
28.Wang, CJ, Leung, SW, Chen, HC et al. (1998) The correlation of acute toxicity and late rectal injury in radiotherapy for cervical carcinoma: evidence suggestive of consequential late effect (CQLE). Int J Rad Oncol Biol Phys 40, 85–91.
29.Heemsbergen, WD, Peeters, STH, Koper, PCM et al. (2006) Acute and late gastrointestinal toxicity after radiotherapy in prostate cancer patients: consequential late damage. Int J Rad Oncol Biol Phys 66, 3–10.
30.Wedlake, LJ, Thomas, K, Lalji, A et al. (2010) Predicting late effects of pelvic radiotherapy: is there a better approach? Int J Radiat Oncol Biol Phys 78, 1163–1170.
31.McGough, C, Baldwin, C, Frost, G et al. (2004) Role of nutritional intervention in patients treated with radiotherapy for pelvic malignancy. Br J Cancer 90, 2278–2287.
32.Wedlake, LJ, Shaw, C, Whelan, L et al. (2013) Systematic review: the efficacy of nutritional interventions to counteract acute gastrointestinal toxicity during therapeutic pelvic radiotherapy. Aliment Pharmacol Ther 37, 1046–1056.
33.Henson, CC, Burden, S, Davidson, SE et al. (2013) Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy. Cochrane Database Syst Rev Nov 26:(II) CD009896.
34.Lawrie, TA, Green, JT, Beresford, M et al. (2018) Interventions to reduce acute and late gastrointestinal effects of pelvic radiotherapy. Cochrane Database Syst Rev Jan 23:I: CD012529.
35.Kaushik, N, Pietraszewski, M, Holst, J et al. (2005) Enteral feeding without pancreatic stimulation. Pancreas 31, 353–359.
36.Vu, M, Van der Veek, P, Frolich, M et al. (1999) Does jejunal feeding activate exocrine pancreatic secretion? Eur J Clin Investig 29, 1053–1059.
37.O'Keefe, S, Lee, R, Anderson, F et al. (2002) Physiological effects of enteral and parenteral feeding on pancreatobiliary secretion in humans. Am J Physiol Gastrointest Liver Physiol 284, G27–G36.
38.Brown, M, Buchanan, R & Karran, S (1980) Clinical observations on the effects of elemental diet supplementation during irradiation. Clin Radiol 31, 19–20.
39.Capirci, C, Polico, C, Amichetti, M et al. (2000) Diet prevention of radiation acute enteric toxicity: multicentric randomised study. Radiother Oncol 56, Suppl. 1, S44.
40.McGough, C, Wedlake, L, Baldwin, C et al. (2008) Clinical trial: normal diet vs. partial replacement with oral E028 formula for the prevention of gastrointestinal toxicity in cancer patients undergoing pelvic radiotherapy. Aliment Pharmacol Ther 27, 1132–1139.
41.Foster, K, Brown, M, Alberti, K et al. (1980) The metabolic effects of abdominal irradiation in man with and without dietary therapy with an elemental diet. Clin Radiol 31, 13–17.
42.Craighead, P & Young, S (1998) Phase II study assessing the feasibility of using elemental supplements to reduce acute enteritis in patients receiving radical pelvic radiotherapy. Am J Clin Oncol 21, 573–578.
43.McArdle, A, Reid, E & Laplante, M (1986) Prophylaxis against radiation injury. The use of elemental diet prior to and during radiotherapy for invasive bladder cancer and in early postoperative feeding following radical cystectomy and ileal conduit. Arch Surg 121, 879–885.
44.Department of Health. Report on Health and Social Subjects no. 41 (1991) Dietary reference values for food energy and nutrients for the United Kingdom. Report of the Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy. London:HMSO.
45.Hauer-Jensen, M, Wang, J & Denham, J (2003) Bowel injury: current and evolving management strategies. Semin Radiat Oncol 13, 357–371.
46.Middleton, SJ, Rucker, JT, Kirby, GA et al. (1995) Long-chain tryglycerides reduce the efficacy of enteral feeds in patients with active Crohn's disease. Clin Nutr 14, 229–236.
47.Boseaus, I, Andersson, H & Nystro, C (1979) Effect of a low-fat diet on bile salt excretion and diarrhoea in the gastrointestinal radiation syndrome. Acta Radiol Oncol 18, 460–464.
48.Symersky, T, Vu, M, Frolich, M et al. (2002) The effect of equicaloric medium-chain and long-chain triglycerides on pancreas enzyme secretion. Clin Physiol Funct Imaging 22, 307–311.
49.Karlson, S, Kahn, JM, Portman, W et al. (1989) A randomised trial with low fat diets to improve food intake and tolerance in women receiving abdominal radiotherapy for cancer. Clin Nutr 8(Special Suppl), 39.
50.Wedlake, L, McGough, C, Shaw, C et al. (2012) Clinical trial: efficacy of a low or modified fat diet for the prevention of gastrointestinal toxicity in patients receiving radiotherapy for pelvic malignancies. J Hum Nutri Diet 25, 247–259.
51.Suarez, F, Savaiano, D & Levitt, MD (1995) A comparison of symptoms after the consumption of milk or lactose-hydrolysed milk by people with self-reported severe lactose intolerance. NEJM 333, 1–4.
52.Weiss, RG & Stryker, JA (1982) 14C-Lactose breath tests during pelvic radiotherapy: the effect of the amount of small bowel irradiated. Radiology 142, 507–510.
53.Stryker, JA & Bartholomew, M (1986) Failure of lactose-restricted diets to prevent radiation-induced diarrhoea in patients undergoing whole pelvis irradiation. Int J Radiat Oncol Biol Phys 12, 789–792.
54.Cummings, JH, Mann, JI, Hishida, C et al. (2009) Dietary fibre: an agreed definition. Lancet 373, 365–366.
55.Cook, SI & Selin, JH (1998) Review article: short chain fatty acids in health and disease. Aliment Pharmacol Ther 12, 449–507.
56.Hamer, HM, Jonkers, D, Venema, K et al. (2008) Review article: the role of butyrate on colonic function. Aliment Pharmacol Ther 27, 104–119.
57.Lodge, N, Evans, ML, Wilkins, M et al. (1995) A randomised cross-over study of the efficacy of codeine phosphate versus Ispaghulahusk in patients with gynaecological cancer experiencing diarrhoea during pelvic radiotherapy. Eur J Cancer Care 4, 8–10.
58.Liu, L, Glicksman, A, Coachman, N et al. (1997) Low acute gastrointestinal and genitourinary toxicities in whole pelvic irradiation of prostate cancer. Int J Rad Oncol Biol Phys 38, 65–71.
59.Murphy, J, Stacey, D, Crook, J et al. (2000) Testing control of radiation-induced diarrhoea with psyllium bulking agent: a pilot study. Can Oncol Nurs J 10, 96–100.
60.McNair, HA, Wedlake, LJ, McVey, G et al. (2011) Can diet combined with treatment scheduling achieve consistency of rectal filling in patients receiving radiotherapy to the prostate? Radiother Oncol 101, 471–478.
61.Pettersson, A, Johansson, B, Persson, C et al. (2012) Effects of a dietary intervention on acute gastrointestinal side-effects and other aspects of health-related quality of life: a randomised controlled trial in prostate cancer patients undergoing radiotherapy. Radiother Oncol 103, 333–340.
62.Pettersson, A, Nygren, P, Persson, C et al. (2014) Effects of a dietary intervention on gastrointestinal symptoms after prostate cancer radiotherapy: long-term results from a randomised controlled trial. Radiother Oncol 113, 240–247.
63.Itoh, Y, Mizuno, M, Ikeda, M et al. (2015) A randomised, double-blind pilot trial of hydrolysed rice bran versus placebo for radioprotective effect on acute gastroenteritis secondary to chemoradiotherapy in patients with cervical cancer. Evid-Based Complement Altern Med Available at: https://www.hindawi.com/journals/ecam/2015/974390/.
64.Garcia-Peres, P, Velasco, C, Hernandez, M et al. (2016) Effect of inulin and fructo-oligosaccharide on the prevention of acute radiation enteritis in patients with gynaecological cancer and impact on quality-of-life: a randomized, double-blind, placebo-controlled trial. Eur J Clin Nutri 70, 170–174.
65.Wedlake, L, Shaw, C, McNair, H et al. (2017) Randomized controlled trial of dietary fiber for the prevention of radiation-induced gastrointestinal toxicity during pelvic radiotherapy. Am J Clin Nutri 106, 849–857.
66.Food and Agriculture Organisation of the United Nations and World Health Organisation Working Group (2002) Guidelines for the evaluation of probiotics in food. Geneva, Switzerland: FAO/WHO.
67.Gibson, GR, Probert, HM, Van Loo, J et al. (2004) Dietary modulation of the human colonic microbiota: updating the concept of prebiotics. Nut Res Rev 17, 259–275.
68.Gerritsen, J, Smidt, H, Rijkers, G et al. (2011) Intestinal microbiota in human health and disease; the impact or probiotics. Genes Nutr 6, 209–240.
69.Salminen, E, Elomaa, I, Minkkinen, J et al. (1988) Preservation of intestinal integrity during radiotherapy using live Lactobacillus acidophilis cultures. Clin Radiol 39, 435–437.
70.Urbancsek, H, Kazar, T, Mezes, I et al. (2001) Results of a double-blind, randomised study to evaluate the efficacy and safety of Antibiophilus in patients with radiation-induced diarrhoea. Euro J Gastro Hepatol 13, 391–396.
71.Delia, P, Sansotta, G, Donato, V et al. (2007) Use of probiotics for prevention of radiation-induced diarrhea. World J Gastroenterol 13, 912–915.
72.Giralt, J, Regadera, JP, Verges, R et al. (2008) Effects of probiotic Llactobacillus casei DN-114 001 in the prevention of radiation-induced diarrhea: results from multicentre, randomised, placebo-controlled nutritional trial. Int J Rad Oncol Biol Phys 71, 1213–1219.
73.Chitapanarux, I, Chitapanarux, T, Traisathit, P et al. (2010) Randomised controlled trial of live Lactobacillus acidophilus plus bifidobacterium in prophylaxis of diarrhea during radiotherapy in cervical cancer patients. Radiat Oncol 5, 31.
74.Delia, P, Sansotta, G, Donato, V et al. (2002) Prophylaxis of diarrhoea in patients submitted to radiotherapeutic treatment on pelvic district: personal experience. Digest Liver Dis 34, Suppl. 2, S84–S86.
75.Delia, P, Sansotta, G, Donato, V et al. (2002) Prevention of radiation-induced diarrhoea with the use of VSL#3, a new high-potency probiotic preparation. Am J Gastro 97, 2150–2152.
76.Timko, J (2010) Probiotics as prevention of radiation-induced diarrhoea. J Radiother Pract 9, 201–208.
77.Demers, M, Dagnault, A & Desjardins, J (2014) A randomized double-blind controlled trial: impact of probiotics on diarrhea in patients treated with pelvic radiation. Clin Nutr 33, 761–767.
78.Nascimento, M, Aguilar-Nascimento, JE, Caporossi, C et al. (2014) Efficacy of synbiotics to reduce acute radiation proctitis symptoms and improve quality of life: a randomised, double-blind, placebo-controlled pilot trial. Int J Radiat Oncol Biol Phys 90, 289–295.
79.Mansouri-Tehrani, HS, Rabbani Khorasgani, M & Roayaei, M (2016) Effects of probiotics with or without honey on radiation-induced diarrhoea. Int J Radiat Res 14, 205–213.
80.Lalla, RV, Bowen, J, Barasch, A et al. (2014) Multinational Association for Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for the management of mucositis secondary to cancer therapy. Cancer 120, 1453–1461.
82.Ravasco, P, Monteiro-Grillo, I, Vidal, PM et al. (2005) Dietary counseling improves patient outcomes: a prospective, randomised, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol 23, 1431–1438.
83.Ravasco, P, Monteiro-Grillo, I & Camilo, M (2012) Individualised nutrition intervention is of major benefit to colorectal cancer patients: long-term follow-up of a randomised controlled trial of nutrition therapy. Am J Clin Nutr 96, 1346–1353.