{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:13:12Z","timestamp":1790097192426,"version":"4.0.1"},"reference-count":74,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2023,8,9]],"date-time":"2023-08-09T00:00:00Z","timestamp":1691539200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"3D-Matrix","award":["302062"],"award-info":[{"award-number":["302062"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Pelvic radiotherapy can damage surrounding tissue and organs, causing chronic conditions including bowel symptoms. We systematically identified quantitative, population-based studies of patient-reported bowel symptoms following pelvic radiotherapy to synthesize evidence of symptom type, prevalence, and severity. Medline, CINAHL, EMBASE, and PsychINFO were searched from inception to September 2022. Following independent screening of titles, abstracts, and full-texts, population and study characteristics and symptom findings were extracted, and narrative synthesis was conducted. In total, 45 papers (prostate, n = 39; gynecological, n = 6) reporting 19 datasets were included. Studies were methodologically heterogeneous. Most frequently assessed was bowel function (\u2018score\u2019, 26 papers, \u2018bother\u2019, 19 papers). Also assessed was urgency, diarrhea, bleeding, incontinence, abdominal pain, painful hemorrhoids, rectal wetness, constipation, mucous discharge, frequency, and gas. Prevalence ranged from 1% (bleeding) to 59% (anal bleeding for &gt;12 months at any time since start of treatment). In total, 10 papers compared radiotherapy with non-cancer comparators and 24 with non-radiotherapy cancer patient groups. Symptom prevalence\/severity was greater\/worse in radiotherapy groups and symptoms more common\/worse post-radiotherapy than pre-diagnosis\/treatment. Symptom prevalence varied between studies and symptoms. This review confirms that many people experience chronic bowel symptoms following pelvic radiotherapy. Greater methodological consistency, and investigation of less-well-studied survivor populations, could better inform the provision of services and support.<\/jats:p>","DOI":"10.3390\/cancers15164037","type":"journal-article","created":{"date-parts":[[2023,8,9]],"date-time":"2023-08-09T10:21:50Z","timestamp":1691576510000},"page":"4037","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["A Systematic Review of Population-Based Studies of Chronic Bowel Symptoms in Cancer Survivors following Pelvic Radiotherapy"],"prefix":"10.3390","volume":"15","author":[{"given":"Adam","family":"Biran","sequence":"first","affiliation":[{"name":"Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iakov","family":"Bolnykh","sequence":"additional","affiliation":[{"name":"Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4110-0588","authenticated-orcid":false,"given":"Ben","family":"Rimmer","sequence":"additional","affiliation":[{"name":"Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Cunliffe","sequence":"additional","affiliation":[{"name":"NHS Southwest London Clinical Commissioning Group, London SW19 1RH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Durrant","sequence":"additional","affiliation":[{"name":"Somerset NHS Foundation Trust, Taunton TA1 5DA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Hancock","sequence":"additional","affiliation":[{"name":"North Tees and Hartlepool NHS Foundation Trust, Hartlepool TS24 9AH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Ludlow","sequence":"additional","affiliation":[{"name":"Llandough, Cardiff and Vale University Health Board, Cardiff CF64 2XX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Pedley","sequence":"additional","affiliation":[{"name":"Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne NE3 3HD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Rees","sequence":"additional","affiliation":[{"name":"Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9515-1722","authenticated-orcid":false,"given":"Linda","family":"Sharp","sequence":"additional","affiliation":[{"name":"Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"389","DOI":"10.3109\/00365521.2010.545832","article-title":"\u201cPelvic radiation disease\u201d: New understanding and new solutions for a new disease in the era of cancer survivorship","volume":"46","author":"Andreyev","year":"2010","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"40","DOI":"10.12968\/gasn.2020.18.2.40","article-title":"Gastrointestinal symptoms of pelvic radiation disease (part 1): Literature review","volume":"18","author":"Ludlow","year":"2020","journal-title":"Gastrointest. Nurs."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1002\/cncr.10248","article-title":"The association of treatment-related symptoms with quality-of-life outcomes for localized prostate carcinoma patients","volume":"94","author":"Bacon","year":"2002","journal-title":"Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"44","DOI":"10.12968\/gasn.2020.18.3.44","article-title":"Gastrointestinal symptoms of pelvic radiation disease (part 2): Impact on patients and carers","volume":"18","author":"Ludlow","year":"2020","journal-title":"Gastrointest. Nurs."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1055\/s-0035-1547337","article-title":"Radiation Proctopathy","volume":"28","author":"Grodsky","year":"2015","journal-title":"Clin. Colon Rectal Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.clon.2007.08.011","article-title":"Gastrointestinal Problems after Pelvic Radiotherapy: The Past, the Present and the Future","volume":"19","author":"Andreyev","year":"2007","journal-title":"Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2180","DOI":"10.1007\/s10620-018-5163-8","article-title":"Management of Radiation Proctitis","volume":"63","author":"Tabaja","year":"2018","journal-title":"Dig. Dis. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"22","DOI":"10.5946\/ce.2020.288","article-title":"Radiation Proctitis and Management Strategies","volume":"55","author":"Dahiya","year":"2022","journal-title":"Clin. Endosc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"26","DOI":"10.12968\/gasn.2020.18.4.26","article-title":"Pelvic radiation disease (part 3): Indentification, investigations, findings and management","volume":"18","author":"Ludlow","year":"2020","journal-title":"Gastrointest. Nurs."},{"key":"ref_10","unstructured":"(2023, March 05). Best Practice Pathway for Pelvic Radiation Disease. Available online: https:\/\/www.prda.org.uk\/wp-content\/uploads\/2022\/09\/PRDA_Best-Practice-Pathway_Toolkit.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1046\/j.1445-2197.2003.02748.x","article-title":"Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument","volume":"73","author":"Slim","year":"2003","journal-title":"ANZ J. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s11764-020-00862-2","article-title":"Long-term work retention after treatment for cancer: A systematic review and meta-analysis","volume":"14","author":"Torp","year":"2020","journal-title":"J. Cancer Surviv."},{"key":"ref_14","unstructured":"Popay, J., Roberts, H., Sowden, A., Petticrew, M., Arai, L., Rodgers, M., Britten, N., Roen, K., and Duffy, S. (2006). Guidance on the Conduct of Narrative Synthesis in Systematic Reviews: A product from the ESRC Methods Programme, Lancaster University."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1007\/s11764-021-01077-9","article-title":"Disability pension among gynaecological cancer survivors with or without radiation-induced survivorship syndromes","volume":"16","author":"Baloch","year":"2021","journal-title":"J. Cancer Surviv."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1001\/jama.2017.1704","article-title":"Association Between Radiation Therapy, Surgery, or Observation for Localized Prostate Cancer and Patient-Reported Outcomes After 3 Years","volume":"317","author":"Barocas","year":"2017","journal-title":"JAMA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1111\/1754-9485.12433","article-title":"Prospective evaluation of patient-reported quality of life outcomes after external beam radiation treatment for prostate cancer in Victoria: A cohort study by the Victorian Prostate Cancer Registry","volume":"60","author":"Bandarage","year":"2016","journal-title":"J. Med. Imaging Radiat. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1034\/j.1600-0412.2002.810512.x","article-title":"Patient-rating of distressful symptoms after treatment for early cervical cancer","volume":"81","author":"Bergmark","year":"2002","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E36","DOI":"10.1111\/bju.13179","article-title":"Population-based study of long-term functional outcomes after prostate cancer treatment","volume":"117","author":"Carlsson","year":"2015","journal-title":"BJU Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1001\/jama.2017.1652","article-title":"Association Between Choice of Radical Prostatectomy, External Beam Radiotherapy, Brachytherapy, or Active Surveillance and Patient-Reported Quality of Life Among Men With Localized Prostate Cancer","volume":"317","author":"Chen","year":"2017","journal-title":"JAMA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1097\/JU.0000000000002902","article-title":"Patient-reported Outcomes After External Beam Radiotherapy with Low Dose Rate Brachytherapy Boost vs Radical Prostatectomy for Localized Prostate Cancer: Five-year Results From a Prospective Comparative Effectiveness Study","volume":"208","author":"De","year":"2022","journal-title":"J. Urol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/S1470-2045(18)30780-0","article-title":"Quality of life in men living with advanced and localised prostate cancer in the UK: A population-based study","volume":"20","author":"Downing","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s11764-014-0419-6","article-title":"Long-term health-related quality of life of prostate cancer survivors varies by primary treatment. Results from the PiCTure (Prostate Cancer Treatment, your experience) study","volume":"9","author":"Drummond","year":"2015","journal-title":"J. Cancer Surviv."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1111\/IGC.0b013e3181d373bf","article-title":"Fecal Incontinence Affecting Quality of Life and Social Functioning Among Long-Term Gynecological Cancer Survivors","volume":"20","author":"Dunberger","year":"2010","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.ejca.2009.10.023","article-title":"Self-reported symptoms of faecal incontinence among long-term gynaecological cancer survivors and population-based controls","volume":"46","author":"Dunberger","year":"2010","journal-title":"Eur. J. Cancer"},{"key":"ref_26","first-page":"78","article-title":"Late Adverse Health Outcomes and Quality of Life after curative radiotherapy + long-term ADT in Prostate Cancer Survivors: Comparison with men from the general population","volume":"37","author":"Dahl","year":"2022","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1111\/bju.13036","article-title":"Patient-reported \u2018ever had\u2019 and \u2018current\u2019 long-term physical symptoms after prostate cancer treatments","volume":"116","author":"Gavin","year":"2015","journal-title":"BJU Int."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2517","DOI":"10.1200\/JCO.2001.19.9.2517","article-title":"Health Outcomes after External-Beam Radiation Therapy for Clinically Localized Prostate Cancer: Results From the Prostate Cancer Outcomes Study","volume":"19","author":"Hamilton","year":"2001","journal-title":"J. Clin. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1002\/cncr.11233","article-title":"Patient satisfaction with treatment decisions for clinically localized prostate carcinoma. Results from the Prostate Cancer Outcomes Study","volume":"97","author":"Hoffman","year":"2003","journal-title":"Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2306","DOI":"10.1200\/JCO.2016.70.6317","article-title":"Treatment Decision Regret Among Long-Term Survivors of Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study","volume":"35","author":"Hoffman","year":"2017","journal-title":"J. Clin. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1001\/jama.2019.20675","article-title":"Patient-Reported Outcomes Through 5 Years for Active Surveillance, Surgery, Brachytherapy, or External Beam Radiation With or Without Androgen Deprivation Therapy for Localized Prostate Cancer","volume":"323","author":"Hoffman","year":"2020","journal-title":"JAMA"},{"key":"ref_32","first-page":"930.e23","article-title":"Radiotherapy after radical prostatectomy: Effect of timing of postprostatectomy radiation on functional outcomes","volume":"38","author":"Huelster","year":"2020","journal-title":"Urol. Oncol. Semin. Orig. Investig."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4193","DOI":"10.1200\/JCO.2004.09.127","article-title":"Racial\/Ethnic Differences in Functional Outcomes in the 5 Years After Diagnosis of Localized Prostate Cancer","volume":"22","author":"Johnson","year":"2004","journal-title":"J. Clin. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/j.1464-410X.2012.11198.x","article-title":"A national study of adverse effects and global quality of life among candidates for curative treatment for prostate cancer","volume":"111","author":"Kyrdalen","year":"2012","journal-title":"BJU Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.ijrobp.2018.05.043","article-title":"Comparison of Patient-reported Outcomes After External Beam Radiation Therapy and Combined External Beam With Low-dose-rate Brachytherapy Boost in Men With Localized Prostate Cancer","volume":"102","author":"Lee","year":"2018","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1038\/bjc.2017.30","article-title":"Patients\u2019 perceptions of the negative effects following different prostate cancer treatments and the impact on psychological well-being: A nationwide survey","volume":"116","author":"Lehto","year":"2017","journal-title":"Br. J. Cancer"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1038\/s41416-018-0084-z","article-title":"Health-related quality of life after treatment for bladder cancer in England","volume":"118","author":"Mason","year":"2018","journal-title":"Br. J. Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Mazariego, C.G., Egger, S., King, M.T., Juraskova, I., Woo, H., Berry, M., Armstrong, B.K., and Smith, D.P. (2020). Fifteen year quality of life outcomes in men with localised prostate cancer: Population based Australian prospective study. BMJ, 371.","DOI":"10.1136\/bmj.m3503"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.ijrobp.2008.04.004","article-title":"Bowel, Urinary, and Sexual Problems Among Long-Term Prostate Cancer Survivors: A Population-Based Study","volume":"73","author":"Mols","year":"2009","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.eururo.2019.02.026","article-title":"Patient-reported Quality of Life Following Stereotactic Body Radiotherapy and Conventionally Fractionated External Beam Radiotherapy Compared with Active Surveillance Among Men with Localized Prostate Cancer","volume":"76","author":"Moon","year":"2019","journal-title":"Eur. Urol."},{"key":"ref_41","first-page":"101623","article-title":"Patient-reported outcome measures after treatment for prostate cancer: Results from the Danish Prostate Cancer Registry (DAPROCAdata)","volume":"64","author":"Borre","year":"2019","journal-title":"Cancer Epidemiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1200\/JCO.19.01538","article-title":"Patient-Reported Functional Outcomes After Hypofractionated or Conventionally Fractionated Radiation for Prostate Cancer: A National Cohort Study in England","volume":"38","author":"Nossiter","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_43","first-page":"471","article-title":"Patient Reported Comparative Effectiveness of Contemporary Intensity Modulated Radiation Therapy Versus External Beam Radiation Therapy of the Mid 1990s for Localized Prostate Cancer","volume":"5","author":"Hoffman","year":"2017","journal-title":"Urol. Pract."},{"key":"ref_44","first-page":"19","article-title":"Real-world utilisation of brachytherapy boost and patient-reported functional outcomes in men who had external beam radiation therapy for prostate cancer in Australia","volume":"37","author":"Ong","year":"2022","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1016\/j.ijrobp.2020.07.031","article-title":"Toxicity of Pelvic Lymph Node Irradiation With Intensity Modulated Radiation Therapy for High-Risk and Locally Advanced Prostate Cancer: A National Population-Based Study Using Patient-Reported Outcomes","volume":"108","author":"Parry","year":"2020","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.radonc.2020.10.019","article-title":"Patient-reported functional outcomes following external beam radiation therapy for prostate cancer with and without a high-dose rate brachytherapy boost: A national population-based study","volume":"155","author":"Parry","year":"2020","journal-title":"Radiother. Oncol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1016\/j.ijrobp.2020.11.023","article-title":"Impact of High-Dose-Rate and Low-Dose-Rate Brachytherapy Boost on Toxicity, Functional and Cancer Outcomes in Patients Receiving External Beam Radiation Therapy for Prostate Cancer: A National Population-Based Study","volume":"109","author":"Parry","year":"2020","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1912","DOI":"10.1002\/cncr.33388","article-title":"Five\u2013year outcomes from a prospective comparative effectiveness study evaluating external\u2013beam radiotherapy with or without low\u2013dose\u2013rate brachytherapy boost for localized prostate cancer","volume":"127","author":"Pasalic","year":"2021","journal-title":"Cancer"},{"key":"ref_49","first-page":"1582","article-title":"Health Outcomes After Prostatectomy or Radiotherapy for Prostate Cancer: Results From the Prostate Cancer Outcomes Study","volume":"92","author":"Potosky","year":"2000","journal-title":"Gynecol. Oncol."},{"key":"ref_50","first-page":"1358","article-title":"Five-Year Outcomes After Prostatectomy or Radiotherapy for Prostate Cancer: The Prostate Cancer Outcomes Study","volume":"96","author":"Potosky","year":"2004","journal-title":"Gynecol. Oncol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e2129647","DOI":"10.1001\/jamanetworkopen.2021.29647","article-title":"Evaluation of Hypofractionated Radiation Therapy Use and Patient-Reported Outcomes in Men With Nonmetastatic Prostate Cancer in Australia and New Zealand","volume":"4","author":"Pryor","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1056\/NEJMoa1209978","article-title":"Long-Term Functional Outcomes after Treatment for Localized Prostate Cancer","volume":"368","author":"Resnick","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1002\/cncr.10650","article-title":"Complications from treatment for prostate carcinoma among men in the Detroit area","volume":"95","author":"Schwartz","year":"2002","journal-title":"Cancer"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"b4817","DOI":"10.1136\/bmj.b4817","article-title":"Quality of life three years after diagnosis of localised prostate cancer: Population based cohort study","volume":"339","author":"Smith","year":"2009","journal-title":"BMJ"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Steineck, G., Skokic, V., Sj\u00f6berg, F., Bull, C., Alevronta, E., Dunberger, G., Bergmark, K., Wilder\u00e4ng, U., Oh, J.H., and Deasy, J.O. (2017). Identifying radiation-induced survivorship syndromes affecting bowel health in a cohort of gynecological cancer survivors. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0171461"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.eururo.2016.10.036","article-title":"Racial Variation in Patient-Reported Outcomes Following Treatment for Localized Prostate Cancer: Results from the CEASAR Study","volume":"72","author":"Tyson","year":"2016","journal-title":"Eur. Urol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.eururo.2018.02.012","article-title":"Effect of Prostate Cancer Severity on Functional Outcomes After Localized Treatment: Comparative Effectiveness Analysis of Surgery and Radiation Study Results","volume":"74","author":"Tyson","year":"2018","journal-title":"Eur. Urol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.ygyno.2012.06.007","article-title":"Health related quality of life and symptoms after pelvic lymphadenectomy or radiotherapy vs. no adjuvant regional treatment in early-stage endometrial carcinoma: A large population-based study","volume":"127","author":"Pijnenborg","year":"2012","journal-title":"Gynecol. Oncol."},{"key":"ref_59","first-page":"56.e1","article-title":"Association between pelvic nodal radiotherapy and patient-reported functional outcomes through 5 years among men undergoing external-beam radiotherapy for prostate cancer: An assessment of the comparative effectiveness analysis of surgery and radiation (CEASAR) cohort","volume":"40","author":"Wallis","year":"2022","journal-title":"Urol. Oncol. Semin. Orig. Investig."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1111\/bju.14182","article-title":"Urinary, bowel and sexual health in older men from Northern Ireland","volume":"122","author":"Donnelly","year":"2018","journal-title":"BJU Int."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1080\/02841860214963","article-title":"Long-term Symptoms after External Beam Radiation Therapy for Prostate Cancer with Three or Four Fields","volume":"41","author":"Helgason","year":"2002","journal-title":"Acta Oncol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/S0090-4295(99)80458-0","article-title":"Effect of pelvic radiotherapy for prostate cancer on bowel, bladder, and sexual function: The patient\u2019s perspective","volume":"47","author":"Crook","year":"1996","journal-title":"Urology"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Sharp, L., Cotton, S., Little, J., Gray, N.M., Cruickshank, M., Smart, L., Thornton, A., Waugh, N., Walker, L., and on behalf of the TOMBOLA group (2013). Psychosocial Impact of Alternative Management Policies for Low-Grade Cervical Abnormalities: Results from the TOMBOLA Randomised Controlled Trial. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0080092"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1002\/pon.3461","article-title":"Bladder and bowel symptoms in cervical and endometrial cancer survivors","volume":"23","author":"Donovan","year":"2014","journal-title":"Psycho-Oncology"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.clon.2018.01.016","article-title":"Older Age, Early Symptoms and Physical Function are Associated with the Severity of Late Symptom Clusters for Men Undergoing Radiotherapy for Prostate Cancer","volume":"30","author":"Lemanska","year":"2018","journal-title":"Clin. Oncol."},{"key":"ref_66","first-page":"4","article-title":"Modified fragility index and surgical complexity score are able to predict postoperative morbidity and mortality after cytoreductive surgery for advanced ovarian cancer","volume":"161","author":"Giannini","year":"2020","journal-title":"Gynecol. Oncol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.radonc.2004.05.006","article-title":"Long-term bladder, colorectal, and sexual functions after radical radiotherapy for urinary bladder cancer","volume":"72","author":"Fokdal","year":"2004","journal-title":"Radiother. Oncol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"111","DOI":"10.5489\/cuaj.5997","article-title":"Evaluating the measurement properties of the 26-item Expanded Prostate Cancer Index Composite (EPIC-26) with a multicenter cohort","volume":"14","author":"Crump","year":"2019","journal-title":"Can. Urol. Assoc. J."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.radonc.2010.04.001","article-title":"EORTC radiation proctitis-specific quality of life module\u2013Pretesting in four European countries","volume":"97","author":"Halkett","year":"2010","journal-title":"Radiother. Oncol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1186\/s13014-018-1107-x","article-title":"International validation of the EORTC QLQ-PRT20 module for assessment of quality of life symptoms relating to radiation proctitis: A phase IV study","volume":"13","author":"Halkett","year":"2018","journal-title":"Radiat. Oncol."},{"key":"ref_71","unstructured":"(2023, February 23). About Pelvic Radiation Disease (PRD)|Jo\u2019s Cervical Cancer Trust. (n.d.). Available online: https:\/\/www.jostrust.org.uk\/information\/living-with-cervical-cancer\/prd\/about."},{"key":"ref_72","unstructured":"(2023, February 23). Patient Stories\u2013PRDA. (n.d.). Available online: https:\/\/www.prda.org.uk\/patient-stories\/."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Ludlow, H., Green, J., and Turner, J. (2017). Late gastrointestinal effects of pelvic radiation: A nurse-led service. Br. J. Nurs., 26.","DOI":"10.12968\/bjon.2017.26.4.S15"},{"key":"ref_74","unstructured":"IARC, and WHO (2023, March 05). Data Visualization Tools for Exploring the Global Cancer Burden in 2020. Available online: https:\/\/gco.iarc.fr\/today\/home."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/16\/4037\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:29:48Z","timestamp":1760128188000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/16\/4037"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,9]]},"references-count":74,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["cancers15164037"],"URL":"https:\/\/doi.org\/10.3390\/cancers15164037","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,9]]}}}