Individualized strategies for peptide-based formulas in the management of radiotherapy-induced intestinal toxicity

Ko Chihyuan; Lian Tingting; Zhuang Zehao

doi:10.16689/j.cnki.cn11-9349/r.2026.01.008

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Electronic Journal of Metabolism and Nutrition of Cancer ›› 2026, Vol. 13 ›› Issue (1) : 52-58. DOI: 10.16689/j.cnki.cn11-9349/r.2026.01.008

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Individualized strategies for peptide-based formulas in the management of radiotherapy-induced intestinal toxicity

¹Ko Chihyuan, ²Lian Tingting, ³Zhuang Zehao

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Abstract

Radiotherapy-related intestinal toxicity commonly presents with diarrhea, abdominal pain, malabsorption, and weight loss, impairing quality of life and potentially compromising radiotherapy delivery. This review focuses on clinical phenotypes across the acute-to-chronic spectrum and highlights diagnostic and differential diagnostic considerations, including infectious and medication-related diarrhea as well as reversible malabsorptive mechanisms such as bile acid malabsorption, exocrine pancreatic insufficiency, and small intestinal bacterial overgrowth. Based on this, enteral nutrition recommendations are proposed. Short-peptide/semi-elemental formulas, which use hydrolyzed protein as the primary nitrogen source and are often rich in medium-chain triglycerides, are suitable as short-term transitional regimens for patients with moderate-to-severe intestinal toxicity, persistent feeding intolerance, or confirmed/strongly suspected malabsorption. For most patients with essentially intact or recoverable bowel function, whole-protein formulas offer advantages in terms of compliance and cost-effectiveness and are appropriate for long-term maintenance. Current evidence does not support the superiority of short-peptide formulas over whole-protein formulas in clinical outcomes. Therefore, a problem-oriented, individualized strategy is recommended: upgrade to short-peptide formulas when necessary and step back to whole-protein-based nutrition in a timely manner. This process should be carried out alongside etiological assessment, symptomatic treatment, and disease-specific management, avoiding overreliance on formula switching at the expense of comprehensive diagnosis and integrated care.

Key words

Radiotherapy / Intestinal toxicity / Enteral nutrition / Radiation enteritis / Peptide-based formula / Individualized strategy / Nutritional management / malabsorption

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Ko Chihyuan, Lian Tingting, Zhuang Zehao. Individualized strategies for peptide-based formulas in the management of radiotherapy-induced intestinal toxicity[J]. Electronic Journal of Metabolism and Nutrition of Cancer. 2026, 13(1): 52-58 https://doi.org/10.16689/j.cnki.cn11-9349/r.2026.01.008

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