The impact of pelvic radiotherapy on the gut microbiome and its role in radiation-induced diarrhoea: a systematic review
Open accessAbstract
Pelvic radiotherapy is the key treatment for pelvic malignancies, usually including pelvic primary tumour lesions and lymphatic drainage areas in the pelvic region. Therefore, the intestinal tract in the radiation field is inevitably damaged, a phenomenon clinically referred to as radiation enteritis, and diarrhoea is the most common clinical symptom of radiation enteritis. Therefore, it is necessary to study the mechanism of radiation-induced diarrhoea. It has been found that the gut microbiome plays an important role in the development of diarrhoea in response to pelvic radiotherapy, and the species and distribution of intestinal microbiota are significantly altered in patients after pelvic radiotherapy. In this study, we searched for articles indexed in the Cochrane Library, Web of Science, EMBASE and PubMed databases in English and CNKI, Wanfang data and SINOMED in Chinese from their inception dates through 13 March 2020 to collect studies on the gut microbiome in pelvic radiotherapy patients. Eventually, we included eight studies: one study report on prostatic carcinoma, five studies on gynaecological carcinoma and two papers on pelvic carcinomas. All studies were designed as self-controlled studies, except for one that compared toxicity to nontoxicity. The results from all the studies showed that the diversity of intestinal flora decreased during and after pelvic radiotherapy, and the diversity of intestinal flora decreased significantly in patients with diarrhoea after radiotherapy. Five studies observed that the community composition of the gut microbiota changed at the phylum, order or genus level before, during, and after pelvic radiotherapy at different time points. In addition, the composition of the gut microbiota before radiotherapy was different between patients with postradiotherapy diarrhoea and those without diarrhoea in five studies. However, relevant studies have not reached consistent results regarding the changes in microbiota composition. Changes in the intestinal flora induced by pelvic radiotherapy and their relationship between changes in intestinal flora and the occurrence of radiation-induced diarrhoea (RID) are discussed in this study, providing a theoretical basis for the causes of RID after pelvic radiotherapy.
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Oncological treatment (chemotherapy and radiotherapy) has a high predisposition to gastrointestinal toxicity such as oral mucositis, constipation, esophagitis, intestinal perforations, hypertransaminasemia, and diarrhea.
“This may be due to high predisposition in oncological treatment (chemotherapy and radiotherapy) related to gastrointestinal toxicity such as oral mucositis, constipation, esophagitis, intestinal perforations, hypertransaminasemia and the presence of diarrhea [85].”
From The Seven Methods for the Evaluation of Nutritional Status—ABCDEFG: Narrative Review (2026) · cites this paper as [85]
The Background (page unavailable) reports that diarrhoea is common after pelvic radiotherapy and that its incidence is higher with concurrent chemotherapy. The paper does not substantiate the cited sentence’s broader list of toxicities—oral mucositis, constipation, esophagitis, intestinal perforations, and hypertransaminasemia. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSupplementing with probiotics provides immunological and non-immunological benefits with respect to GALT in oncologic patients submitted to medical therapies.
“Therefore, a nutritional strategy would be to supplement with probiotics (live microorganisms) that provide immunological and non-immunological benefits with respect to the lymphoid tissue associated with the intestinal mucosa (GALT) in the oncologic patient submitted to medical therapies [85,86].”
From The Seven Methods for the Evaluation of Nutritional Status—ABCDEFG: Narrative Review (2026) · cites this paper as [85]
The Discussion (page unavailable) says probiotics may reduce diarrhoea after pelvic radiotherapy, although findings are inconsistent. It also says the gut microbiota influences mucosal immunity, but does not establish that probiotic supplementation provides both immunological and non-immunological benefits to GALT in cancer patients receiving medical therapies. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIntestinal dysbiosis induced by chemotherapeutic agents and radiotherapy typically manifests through gastrointestinal symptoms such as diarrhea, abdominal pain, and abdominal distension.
“This alteration of the intestinal microbiota, induced by chemotherapeutic agents and exposure to radiotherapy [85], is referred to as intestinal dysbiosis.It is typically manifested through gastrointestinal symptoms such as diarrhea, abdominal pain, and abdominal distension.”
From The Seven Methods for the Evaluation of Nutritional Status—ABCDEFG: Narrative Review (2026) · cites this paper as [85]
The Discussion and Conclusions report that pelvic radiotherapy alters gut microbiota and that these changes correlate with radiation-induced diarrhoea, while noting that a causal relationship has not been established. The Background lists diarrhoea, abdominal pain, and bloating as symptoms of radiation-induced intestinal injury, not specifically as manifestations of dysbiosis. The paper does not establish that chemotherapeutic agents induce the microbiota alteration described in the claim. Page numbers are unavailable in our copy. (LLM, conf=0.86)
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- Authors
- Wang, L., Wang, X., Zhang, G., Ma, Y., Zhang, Q., Li, Z., Ran, J., Hou, X., Geng, Y., Yang, Z., Feng, S., Li, C., & Zhao, X.
- Affiliations
- First Hospital of Lanzhou University (CN)
- Chinese Academy of Sciences (CN)
- Gansu University of Traditional Chinese Medicine (CN)
- Lanzhou University (CN)
- Corresponding author
- Wang, Xiaohu
- ORCID
- Venue
- Radiation Oncology
- Published
- 2021-09-25
- Volume
- 16
- Issue
- 1
- Pages
- 187-187
- ISSN
- 1748-717X (ISSN-L)
- PMC
- PMC8466721
- OpenAlex
- W3204692099
- Cited by
- 48
- References
- 48
- Citations by year
- 2026: 10 · 2025: 9 · 2024: 12 · 2023: 11 · 2022: 6
- FWCI
- 0.76
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Radiation Oncology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Lanzhou University Institutional Repository (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Natural Science Foundation of China regional science foundation project (82060553)
- Talent Innovation and Venture Project of Lanzhou City (2017-RC-23)
- The Hospital Fund Project of the First Hospital of Lanzhou University (ldyyyn2018-09)
- The Lanzhou Science and Technology Development guiding project (2019-ZD-45)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Effects of Radiation Exposure
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Keywords
- pelvic radiotherapy, gut microbiota, radiation enteritis, microbiota composition, prostate cancer, radiation toxicity
- MeSH terms
- Gastrointestinal Microbiome, Diarrhea, Humans, Pelvis, Radiation Injuries
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