Guidelines for Complications of Cancer Treatment Vol VIII Part B

like ultrasonography, CT scan, endoscopy, tests formalabsorption (eg, fecal fat excretion, lactose absorption testSchilling test), and maldigestion (eg, xylose breath test),measurement of intestinal transit, microflora assessment tests,and histopathological examination of mucosal biopsies.Anti-peristaltic drugs, like loperamide or codeine phosphatewhen taken 30-60 min prior to meals may often be sufficientto manage diarrhea and malabsorption. Patients must beadvised to avoid unabsorbed sugars, spices, chilies and starchesand a dietician reference is recommended. Symptomatictherapy is helpful in reducing distress in the acute period.Nausea and vomiting are usually responsive to antiemeticslike metochlopramide or, in severe cases, ondansetron orgranisetron (5-hydroxytryptamine antagonists) maybe given.Henriksson et al., found that sucralfate significantly reducedthe frequency of defecation and improved the stool consistency,with lowered requirements of symptomatic treatment withloperamide.B: Recto-sigmoid toxicitiesRectosigmoid toxicity is dose limiting during pelvicradiotherapy. Total doses of less than 40Gy rarely causeclinically significant symptoms. Nevertheless, pelvic tumorsare usually treated to doses in the range of 50-70Gy, whichresult in significant acute morbidity, including abdominal pain,cramps, diarrhea and hematochesia. In a few patients, thesesymptoms may require treatment interruptions or othermodifications that hinder optimal completion of plannedtreatment. Some patients may develop symptoms of chronicinjury, usually after a latent period of few months or years.Perezet al., in their study of 1456 patients from Mallinckrodt founda 1-4% incidence of major rectal complications when patientsreceived doses less or equal to 8000 Gy, versus a rate of 9% atdoses greater than 8000 Gy. Schultheiss in a study from FoxChase, suggested that the dose resulting in 5% and 50%268