***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background A recent r and omised trial suggested that an algorithmic approach to investigating and managing gastrointestinal symptoms of pelvic radiation disease ( PRD ) is beneficial and that specially trained nurses can manage patients as effectively as a gastroenterologist . Aims The aim of the development and peer review of the guide was to make the algorithm used in the trial accessible to all levels of clinician . Methods Experts who manage patients with PRD were asked to review the guide , rating each section for agreement with the recommended measures and suggesting amendments if necessary . Specific comments were discussed and incorporated as appropriate , and this process was repeated for a second round of review . Results 34 gastroenterologists , 10 nurses , 9 dietitians , 7 surgeons and 5 clinical oncologists participated in round one . Consensus ( defined prospect ively as 60 % or more panellists selecting ‘ strongly agree ’ or ‘ agree ’ ) was reached for 27 of the original 28 sections in the guide , with a median of 75 % of panellists agreeing with each section . 86 % of panellists agreed that the guide was acceptable for publication or acceptable with minor revisions . 55 of the original 65 panellists participated in round two . 89 % agreed it was acceptable for publication after the first revision . Further minor amendments were made in response to round two . Conclusions Development of the guide in response to feedback included ▸ improvement of occasional algorithmic steps ▸ a more user-friendly layout ▸ clearer timeframes for referral to other teams ▸ expansion of reference list ▸ addition of procedures to the appendix Although pelvic irradiation is effective for the treatment of various cancer types , many patients who receive radiotherapy  experience serious complications . Gut microbial dysbiosis was hypothesized to be related to the occurrence of radiation-induced complications in cancer patients . Given the lack of clinical or experimental data on the impact of radiation on gut microbiota , a prospect i ve observational study of gut microbiota was performed in gynecological cancer patients receiving pelvic radiotherapy .  In the current study , the overall composition and alteration of gut microbiota in cancer patients receiving radiation  were investigated by 454 pyrosequencing .  Gut microbial composition showed significant differences ( P < 0.001 ) between cancer patients and healthy individuals . The numbers of species-level taxa were severely reduced after radiotherapy ( P < 0.045 ) , and the abundance of each community largely changed . In particular , the phyla Firmicutes and Fusobacterium were significantly decreased by 10 % and increased by 3 % after radiation therapy , respectively . In addition , overall gut microbial composition was gradually remolded after the full treatment course of pelvic radiotherapy . In this set of cancer patients , dysbiosis of the gut microbiota was linked to health status , and the gut microbiota was influenced by pelvic radiotherapy . Although further studies are needed to eluci date the relationship between dysbiosis and complications induced by pelvic radiotherapy , the current study may offer insights into the treatment of cancer patients suffering from complications after radiation therapy Background Radiation-induced diarrhea is frequently observed during pelvic radiotherapy . This study was performed to determine the ability of a probiotic containing live lactobacillus acidophilus plus bifidobacterium bifidum to reduce the incidence of radiation-induced diarrhea in locally advanced cervical cancer patients . Methods Patients who were undergoing pelvic radiotherapy concurrent with weekly cisplatin  were r and omly assigned to a study drug or placebo , in a double-blind study . Diarrhea was grade d weekly according the Common Toxicity Criteria ( CTC ) system . Stool consistency and white and red blood cell count in stool were also assessed . The primary endpoint was to reduce the incidence of diarrhea , defined by a CTC grade 2 or more , and the need for anti-diarrheal medication . Results A total of 63 patients were enrolled .  Grade 2 -3 diarrhea was observed in 45 % of the placebo group ( n = 31 ) and 9 % of the study drug group ( n = 32 ) ( p = 0.002 ) . Anti-diarrheal medication use was significantly reduced in the placebo group ( p = 0.03 ) . The patients in the study drug group had a significantly improved stool consistency ( p < 0.001 ) . Conclusions Live lactobacillus acidophilus plus bifidobacterium bifidum reduced the incidence of radiation-induced diarrhea and the need for anti-diarrheal medication and had a significant benefits on stool consistency PURPOSE To determine whether a probiotic drink containing Lactobacillus casei DN-114 001 reduces the incidence of radiation-induced diarrhea in patients with gynecologic cancer . METHODS AND MATERIAL S Patients who were undergoing pelvic radiotherapy ( 45 - 50 Gy , conventional fractionation ) for either cervical carcinoma ( radiotherapy and weekly cisplatin ) or endometrial adenocarcinoma ( postoperative radiotherapy ) were r and omly assigned to a probiotic drink or placebo , in a double-blind fashion . The probiotic drink consisted of liquid yogurt containing L. casei DN-114 001 at 10(8 ) CFU/g . The patients recorded the daily the number of bowel movements and scored the stool consistency using the Bristol scale . Diarrhea was grade d weekly according the Common Toxicity Criteria system . The primary endpoint was to reduce the incidence of diarrhea , defined by a Common Toxicity Criteria Grade of 2 or greater or the need for loperamide . RESULTS A total of 85 patients were enrolled .  Grade 2 or greater diarrhea and /or the use of loperamide was observed in 24 of 41 patients in the placebo group and 30 of 44 in the probiotic group ( p = 0.568 ) . No differences were found in the median time to the presentation of the primary endpoint . Probiotic intervention had a significant effect on stool consistency ( p = 0.04 ) . The median time for patients to present with Bristol scale stools of Type 6 or greater was 14 days for patients receiving the probiotic drink vs. 10 days for those receiving placebo . CONCLUSION Nutritional intervention with the probiotic drink containing L. casei DN-114 001 does not reduce the incidence of radiation-induced diarrhea as defined by a Common Toxicity Criteria Grade 2 or greater . However , it had a significant effect on stool consistency as measured by the Bristol scale Summary In a prospect i ve clinical and bacteriological study the endocervical and endometrial flora of 38 patients with biopsy proven cancer of the endometrium was studied before and after  intrauterine irradiation with 10 Gy ( Ir-192 , afterloading device  , Buchler , Braunschweig ) .  Bacteriological swabs were taken transcervically . Anaerobic transport media were used and cultures were done aerobically and anaerobically . The mean number of aerobic organisms per patient increased from 2.13 to 2.49 ( not significant ( n.s . ) ) , and of anaerobic organisms from 1.42 to 2.00 ( n.s . ) . Neither the recovery rate of aerobic and anaerobic bacteria nor the composition of endometrial flora was altered significantly by intracavitary irradiation . Only aerobic sporeformers increased from 5.3 % to 21 % ( 2p < 0.05 ) . The most prevalent aerobic species were 5.S. epidermidis , streptococci and E. coli , the predominant anaerobic speciesPepto- and Peptostreptococcus and Bacteroides . Our results clearly show that the intrauterine administration of 10 Gy by a Ir-192-afterloading device does not sterilize the endocervix or endometrium and infections may occur after intracavitary radiotherapy In the present study , genital aerobic bacterial flora was prospect ively studied in 12 women receiving radiotherapy for gynecologic malignancy . Gram-positive cocci accounted for 59 % and gram-negative bacilli for 27 % of the 26 cervical or vaginal isolates preradiation . A similar pattern of recovery was found during external beam , 60CO whole pelvis radiotherapy . The gram-positive cocci and gram-negative bacilli accounted for 42 and 46 % of the preradiotherapy rectal isolates , respectively . There was no significant change in the pattern of rectal flora during external beam radiotherapy . Thus , results from this preliminary study would indicate that external beam radiotherapy has little or no influence on the major aerobic pathogens in either the cervix , vagina , or rectum 
    Output:
    
The outcomes suggest a correlation between changes in the intestinal microbiome and receiving radiotherapy and showed a decrease in abundance and diversity of the intestinal bacterial species .
Conclusion The limited evidence to date implies that larger studies including both the vaginal and gut microbiome in women treated for a gynecological malignancy are warranted to explore the impact of cancer treatments on the microbiome and its relation to developing long-term gastrointestinal toxicity .