The Effects of Probiotic Supplementation on the Incidence of Diarrhea in Cancer Patients Receiving Radiation Therapy: A Systematic Review with Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials.

Navin Kumar Devaraj,Subapriya Suppiah,Inas Deuraseh,Sajesh K Veettil,Man Jun Soo,Rohit Kunnath Menon,Dhashani Sivaratnam,Kai Wei Lee,Siew Mooi Ching,Fan Kee Hoo

doi:10.3390/nu11122886

Navin Kumar Devaraj, Subapriya Suppiah + Show 8 more

Open Access

https://doi.org/10.3390/nu11122886

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Abstract

The protective effects of probiotic supplementation against radiation-induced diarrhea (RID) have been reported in previous systematic reviews; however so far, only non-conclusive results have been obtained. The objective of this study was to systematically update and evaluate the available evidence for probiotic supplementation. The protocol of this systematic review has been registered (CRD42018106059) with the International Prospective Register of Systematic Reviews (PROSPERO). The primary efficacy outcome was the incidence of RID. Secondary outcomes were the incidence of watery stool, soft stool, and antidiarrheal medication use. There were eight trials, and a total of 1116 participants were included in the primary analysis. Compared with placebo, probiotics were associated with a lower risk of RID [risk ratio (RR) = 0.62, 95% CI = 0.46, 0.83]. A requisite heterogeneity-adjusted trial sequential analysis indicated conclusive evidence for this beneficial effect. No statistically significant reduction in RID (RR = 0.52, 95% CI = 0.14, 1.91) was observed on subgroup analysis in patients receiving both radiation therapy and chemotherapy. However, those patients receiving only radiation therapy (RT) demonstrated significant benefit (RR = 0.61, 95% CI = 0.48, 0.78). There was a significant difference in the antidiarrheal medication use (RR = 0.54, 95% CI = 0.35, 0.84) observed with the use of probiotics. However, no significant difference was observed for the incidence of soft and watery stool. The use of probiotics is beneficial in preventing RID in patients receiving RT.

Highlights

Radiation therapy (RT) is a treatment strategy that conveys energy to eradicate malignant cells in the area targeted by the physician [1]
The studies included were RCTs and those that meet the following inclusion criteria: participants were adult humans who underwent radiotherapy; intervention involved the mandatory use of probiotics; comparators were placebo with or without other base ingredients; and the outcome was the proportion of participants who developed radiation-induced diarrhea (RID)
Based on primary meta-analysis using eight RCTs (n = 1,116), the use of probiotics reduced the risk of RID compared to placebo (RR = 0.62, 95% confidence intervals (CI) = 0.46, 0.83, I2 = 74.4%), with significant heterogeneity (Figure 1)

Summary

Introduction

Radiation therapy (RT) is a treatment strategy that conveys energy to eradicate malignant cells in the area targeted by the physician [1]. In the pelvic region, prostate, gynecological, and colorectal cancers are among the common type of malignancies that may require RT alone or in combination with other treatment strategies [2]. It is recognized as a main treatment option to antagonize the unopposed development and progression of the aforementioned cancers. Radiation-induced diarrhea (RID) often appears during the third week of treatment, with reports of occurrence ranging from 20 to 70 percent [3], and may have a significant negative influence on the patient’s quality of life. At present, there are no effective preventive strategies for RID

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