Amifostine as Radioprotective Agent for the Rectal Mucosa during Irradiation of Pelvic Tumors

Kouvaris, John; Kouloulias, Vassilis; Malas, Elias G.; Antypas, Christos; Kokakis, John; Michopoulos, Spyros; Matsopoulos, George K.; Vlahos, Lambros

doi:10.1007/s00066-003-0970-y

Cited by 48 publications

(7 citation statements)

References 26 publications

(31 reference statements)

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“…The free radical scavenger amifostine, when administered regularly during RT, has shown great potential in preventing acute rectal toxicity. In a randomized trial of 36 patients undergoing a mix of pelvic RT, intrarectal amifostine resulted in a significant decrease in RTOG score ( p < 0.001), a decrease in LENT-SOMA score ( p = 0.002), and improved proctoscopic tissue examination compared to controls [ 46 ]. More recent work has shown that increasing the dose of amifostine results in greater reduction of GI toxicity as determined by the EPIC bowel bothersome score during treatment and at 12 months after external prostate RT [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of the Relationship between Acute and Late Gastrointestinal Toxicity after Radiotherapy for Prostate Cancer

2015

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A small but meaningful percentage of men who are treated with external beam radiation therapy for prostate cancer will develop late gastrointestinal toxicity. While numerous strategies to prevent gastrointestinal injury have been studied, clinical trials concentrating on late toxicity have been difficult to carry out. Identification of subjects at high risk for late gastrointestinal injury could allow toxicity prevention trials to be performed using reasonable sample sizes. Acute radiation therapy toxicity has been shown to predict late toxicity in several organ systems. Late toxicities may occur as a consequential effect of acute injury. In this systematic review of published reports, we found that late gastrointestinal toxicity following prostate radiotherapy seems to be statistically and potentially causally related to acute gastrointestinal morbidity as a consequential effect. We submit that acute gastrointestinal toxicity may be used to identify at-risk patients who may benefit from additional attention for medical interventions and close follow-up to prevent late toxicity. Acute gastrointestinal toxicity could also be explored as a surrogate endpoint for late effects in prospective trials.

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Section: Discussionmentioning

confidence: 99%

Systematic Review of the Relationship between Acute and Late Gastrointestinal Toxicity after Radiotherapy for Prostate Cancer

2015

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“…In an interesting study [34], also supportive of the prophylactic role of amifostine, radiation-induced acute rectal toxicity was evaluated by using three different toxicity scales: WHO scale, EORTC/RTOG toxicity criteria, and a modified toxicity scale. In the present study we have used precisely defined criteria for grading of acute and also of late radiation colitis, based on published reports and textbooks, and thus we were able to semiquantitavely compare histologic changes and endoscopy between groups.…”

Section: Discussionmentioning

confidence: 99%

Randomized phase II exploratory study of prophylactic amifostine in cancer patients who receive radical radiotherapy to the pelvis

Κατσάνος

Briasoulis

Tsekeris

et al. 2010

J Exp Clin Cancer Res

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BackgroundThis study aimed to investigate the efficacy of prophylactic amifostine in reducing the risk of severe radiation colitis in cancer patients receiving radical radiotherapy to the pelvis.MethodsPatients with pelvic tumours referred for radical radiotherapy who consented participation in this trial, were randomly assigned to receive daily amifostine (A) (subcutaneously, 500 mg flat dose) before radiotherapy or radiotherapy alone (R). Sigmoidoscopy and blinded biopsies were scheduled to conduct prior to initiation and following completion of radiotherapy and again 6 to 9 months later. Radiation colitis was assessed by clinical, endoscopic and histolopathological criteria.ResultsA total 44 patients were enrolled in this trial, the majority with rectal (20 patients) and cervical cancer (12 patients) and were assigned 23 in R arm and 21 in the A arm. In total 119 sigmoidoscopies were performed and 18 patients (18/44, 40.9%) were diagnosed with radiation colitis (15 grade 1 and 2, and 3 grade 3 and 4). Of them, 6 patients belonged to the A group (6/21, 28.6%) and 12 to the R group (12/23, 52.2%). Acute and grade IV radiation colitis was only developed in four patients (17.4%) in the R group. Amifostine side effects were mild. Amifostine treated patients were less likely to develop histologically detectable mucosal lesions, which indicate protection from acute mucosal injury.ConclusionsAmifostine given subcutaneously can lower the risk of acute severe radiation colitis in patients who receive radical radiotherapy to pelvic tumors.

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“…In a previous study, Kouvaris et al . [ 24 ] evaluated acute radiation toxicity to the rectal mucosa in 36 patients who had undergone radiotherapy with or without prior intravenous amifostine treatment. Three different toxicity scales were compared: the World Health Organization (WHO) scale, the European Organisation for Research and Treatment of Cancer/Radiation Therapy Oncology Group (EORTC/RTOG) toxicity criteria, and a modified toxicity scale based on the LENT-SOMA grading scale and the endoscopic terminology of the World Organization for Digestive Endoscopy.…”

Section: Relevant Studiesmentioning

confidence: 99%

Cytoprotective Efficacy of Amifostine Against Radiation- Induced Rectal Toxicity: Objective and Subjective Grading Scales for Radiomucositis

Kouloulias

Kouvaris

2008

Molecules

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Curative radiation therapy of pelvic malignancies, frequently results in dose-limiting toxicities such as serous, mucoid, or more rarely, bloody diarrhea. Several studies have evaluated the cytoprotective effects of amifostine in preventing rectal mucositis associated with radiation treatment. We searched Medline for published comparative studies that evaluated the use of amifostine to reduce radiation-induced toxicity associated with pelvic irradiation. In ten studies there was an evidence-based cytoprotection (P<0.05) by amifostine. Although results are variable, current evidence suggests that amifostine may have a radioprotective effect in the rectal mucosa, particularly when administered intrarectally. Significant improvements were seen in both symptomatic and objective (rectosigmoidoscopy) end points. There is a need to conduct well-designed clinical trials with sufficient numbers of participants to confirm these findings together with a cost-benefit study. Objective measurements using rectosigmoidoscopy are superior to subjective measures such as WHO or RTOG/EORTC toxicity grading scales.

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Amifostine as Radioprotective Agent for the Rectal Mucosa during Irradiation of Pelvic Tumors

Abstract: Amifostine seems to have a significant cytoprotective efficacy in acute radiation-induced rectal mucositis in terms of symptomatic and objective endpoints.

Cited by 48 publications

References 26 publications

Systematic Review of the Relationship between Acute and Late Gastrointestinal Toxicity after Radiotherapy for Prostate Cancer

Systematic Review of the Relationship between Acute and Late Gastrointestinal Toxicity after Radiotherapy for Prostate Cancer

Randomized phase II exploratory study of prophylactic amifostine in cancer patients who receive radical radiotherapy to the pelvis

Cytoprotective Efficacy of Amifostine Against Radiation- Induced Rectal Toxicity: Objective and Subjective Grading Scales for Radiomucositis

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