Correspondence - A commentary on The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer

Sep 21, 2026

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A letter commentary addresses a systematic review and meta-analysis evaluating probiotics for preventing chemoradiotherapy-induced diarrhea in abdominal and pelvic cancer patients. It summarizes the rationale linking gut microbiota modulation to host responses, while noting persistent uncertainty due to variable probiotic species, strains, doses, study heterogeneity, and limited quantitative meta-analyses. The discussion highlights the need for CTCAE-graded outcomes, clearer infection risk assessment, and further well-designed trials to identify the most efficacious probiotic combinations.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Correspondence

Clinical background and rationale

Factors influencing diarrhea and probiotic safety

Limitations of the evidence

Future research needs

Ethical and disclosure statements

References

’Correspondence A commentary on ‘The efﬁcacy and safety of probiotics for prevention of chemoradiotherapyinduced diarrhea in people with abdominal and pelvic cancer: a systematic review and metaanalysis based on 23 randomized studies’ Qinjun Cai, MM, Ying Shi, MM* Dear Editor, Cancers are well-known as the leading cause of death. Patients receiving radiotherapy and chemotherapy have a high risk of developing acute chemoradiotherapy-induced diarrhea[1,2] . Several strategies have been proposed to prevent and reduce chemotherapy-related diarrhea. Experimental research has indicated that the host response to cytotoxic agents is modulated by the gut microbiota. Lin and Shen[3] performe d a systematic review and meta-analysis based on 23 randomized controlled trials (RCTs), they indicated that probiotics prevented chemoradiotherapy-induced diarrhea, particularly high-grade diarrhea. Probiotics rarely cause adverse events. In cancer patients, gut microbiota manipulation is considered to be generally safe; however, it is accompanied by risks and controversies that can potentially introduce clinical complications. The use of beneﬁcial live microorganisms (probiotics) is among the most accepted strategies for gut microbiota modulation. A number of factors or their combinations contribute to the development of diarrhea: mucositis and consequent malabsorption, dysbiosis, immunosuppression, tight junction dysfunction, and impaired barrier function. Some cytostatics and their metabolites, such as irinotecan, induce diarrhea directly. The incidence of grade 3/4 diarrhea related to chemotherapy regimens ranges from 5 to 47%[4] . When a bolus of 5-ﬂuorouracil (5-FU) is used in combination with irinotecan, the overall incidence of diarrhea can reach 50–80%[5] . Regarding synthetic molecules, this state is most often induced by 5-FU, capecitabine, irinotecan, and Department of Traditional Chinese Medicine, Beilun District People’s Hospital, Beilun Branch of the First Afﬁliated Hospital of Zhejiang University, Ningbo, People ’s Republic of China All data in this comment is available. Sponsorships or competing interests that maybe relevant to content are disclosed atthe end of this article. *Corresponding author. Address: Beilun District People’s Hospital, Beilun Branch of the First Afﬁliated Hospital of Zhejiang University, Ningbo 315826, People’s Republic of China. Tel.: +137 321 [84011. E-mail: jsehd46@sina.com](84011. E-mail: jsehd46@sina.com) (Y. Shi). Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms. International Journal of Surgery (2024) 110:3097–3098 Received 26 January 2024; Accepted 28 January 2024 Published online 12 February 2024 [http://dx.doi.org/10.1097/JS9.0000000000001172](http://dx.doi.org/10.1097/JS9.0000000000001172) platinum derivatives. Gastrointestinal toxicity could lead to asigniﬁcant impairment of the oncological patient’s quality of life. It should be noted that there were a variety of species, strains, and doses of probiotics used, and therefore, it was difﬁcult to come to any conclusion about the optimum probiotic strategy to use in chemoradiotherapy-induced diarrhea. Individual probiotics may differ greatly in their effects on host immune function, and the reason for their potential therapeutic efﬁcacy remains unclear. Future studies need to establish which species, strain, and dose of probiotics are most efﬁcacious in chemoradiotherapy-induced diarrhea. In addition, the diversity index between the studies (i.e. different types of intervention, duration, and diseases) did not allow a one-to-one comparison between the results. The included RCTs reported additional results,

FAQs

Why is chemoradiotherapy-induced diarrhea a major concern in cancer patients?

Radiotherapy and chemotherapy carry a high risk of acute diarrhea, which can significantly impair quality of life due to gastrointestinal toxicity.

What benefits do the commentary discuss regarding probiotics?

Probiotics are presented as a generally accepted strategy for gut microbiota modulation and may prevent chemoradiotherapy-induced diarrhea, particularly higher-grade diarrhea, with rare adverse events.

What limitations prevent firm conclusions about the optimal probiotic strategy?

Across trials, probiotics differ by species, strain, and dose, and study designs vary, limiting one-to-one comparisons and reducing the ability of quantitative meta-analyses to reach definitive conclusions.

What future studies does the commentary call for?

Future research should determine the most efficacious probiotic species, strains, and doses using CTCAE-graded outcomes, and clarify whether probiotics could lead to infection in cancer patients.

Sep 21, 2026

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