Amphotericin B Lozengers: Prophylaxis for Esophagitis in Thoracic Radiotherapy

Wurstbauer, Karl; Merz, Florian; Sedlmayer, Felix

doi:10.1007/s00066-009-1938-3

Cited by 6 publications

(6 citation statements)

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“…However, their total radiation dose, overall treatment time and MED was in the expected range. The MED, which was according to literature and also in our se- ries highly associated with oesophagitis, was not significantly different between the sequential and concurrent groups [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15]. The incidence and severity of oesophagitis and of neutropenia in the chemoradiation group are also in line with published data [2,3,4,15,19].…”

Section: Discussionsupporting

confidence: 77%

“…If it would be known which microorganisms are surinfecting radiation-induced oesophageal lesions, only the 60% of patients with grade 3 or more neutropenia could receive prophylactic antibiotics and/or anti-mycotic drugs that could decrease symptoms, tube feeding and hospital admissions. An early non-randomised study suggests that the prophylactic use of amphotericin B may indeed be beneficial [10]. However, it remains to be investigated whether this treatment could indeed reduce the incidence of severe oesophagitis, i.e.…”

Section: Schlüsselwörtermentioning

confidence: 99%

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Radiation-induced oesophagitis in lung cancer patients

et al. 2012

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Section: Discussionsupporting

confidence: 77%

Section: Schlüsselwörtermentioning

confidence: 99%

Radiation-induced oesophagitis in lung cancer patients

et al. 2012

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“…Hospitalized radiooncological patients often need an antibiotic or antimycotic medication during radiotherapy [21,22]. Beside those risk factors, the frequency of a treatment with proton pump inhibitor is estimated to be quiet high on radiooncological wards.…”

Section: Discussionmentioning

confidence: 99%

Clostridium difficile-associated diarrhea in radiooncology: an underestimated problem for the feasibility of the radiooncological treatment?

2011

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Background and PurposeOver the last years an increasing incidence of Clostridium difficile-associated diarrhea (CDAD) has been reported. Especially haematology-oncology patients are at risk of developing CDAD.The aim of this analysis is to determine the incidence of CDAD in radiooncological patients and to find out what relevance CDAD has for the feasibility of the radiooncological treatment, as well as to detect and describe risk factors.Patients and MethodsIn a retrospective analysis from 2006 to 2010 34 hospitalized radiooncological patients could be identified having CDAD. The risk factors of these patients were registered, the incidence was calculated and the influence on the feasibility of the radiooncological therapy was evaluated. Induced arrangements for prophylaxis of CDAD were identified and have been correlated with the incidence.ResultsThe incidence of CDAD in our collective is 1,6%. Most of the patients suffering from a CDAD were treated for carcinoma in the head and neck area. Common risk factors were antibiotics, proton pump inhibitors, cytostatic agents and tube feeding.Beside a high rate of electrolyte imbalance and hypoproteinemia a decrease of general condition was frequent. 12/34 patients had a prolonged hospitalization, in 14/34 patients radiotherapy had to be interrupted due to CDAD. In 21 of 34 patients a concomitant chemotherapy was planned. 4/21 patients could receive all of the planned cycles and only 2/21 patients could receive all of the planned cycles in time.4/34 patients died due to CDAD. In 4/34 patients an initially curative treatment concept has to be changed to a palliative concept.With intensified arrangements for prophylaxis the incidence of CDAD decreased from 4,0% in 2007 to 0,4% in 2010.ConclusionThe effect of CDAD on the feasibility of the radiotherapy and a concomitant chemotherapy is remarkable. The morbidity of patients is severe with a high lethality.Reducing of risk factors, an intense screening and the use of probiotics as prophylaxis can reduce the incidence of CDAD.

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“…If parts of the esophagus were within or near the PTV, an antimycotic prophylaxis was given (Amphotericine B lozengers, 4 times daily, during the full course of radiotherapy) [15,16]. …”

Section: Methodsmentioning

confidence: 99%

DART-bid (Dose-differentiated accelerated radiation therapy, 1.8 Gy twice daily)–a novel approach for non-resected NSCLC: final results of a prospective study, correlating radiation dose to tumor volume

et al. 2013

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BackgroundSequential chemo-radiotherapies with intensive radiation components deliver promising results in non-resected non-small cell lung cancer (NSCLC). In general, radiation doses are determined by dose constraints for normal tissues, not by features relevant for tumor control. DART-bid targets directly the doses required for tumor control, correlating doses to tumor volume in a differentiated mode.Materials/MethodsRadiation doses to primary tumors were aligned along increasing tumor size within 4 groups (<2.5 cm/2.5–4.5 cm/4.5–6.0 cm/>6.0 cm; mean number of three perpendicular diameters). ICRU-doses of 73.8 Gy/79.2 Gy/84.6 Gy/90.0 Gy, respectively, were applied. Macroscopically involved nodes were treated with a median dose of 59.4 Gy, nodal sites about 6 cm cranial to involved nodes electively with 45 Gy. Fractional doses were 1.8 Gy twice daily (bid).2 cycles chemotherapy were given before radiotherapy.Between 2004 and 2009, 160 not selected patients with 164 histologically/cytologically proven NSCLC were enrolled; Stage I: 38 patients; II: 6 pts.; IIIA: 69 pts.; IIIB: 47 pts. Weight loss >5%/3 months: 38 patients (24%).Primary endpoints are local and regional tumor control rates at 2 years (as >90% of locoregional failures occur within 2 years). Secondary endpoints are survival and toxicity. With a minimum follow-up time of 2 years for patients alive, the final results are presented.Results32 local and 10 regional recurrences occurred. The local and regional tumor control rates at 2 years are 77% and 93%, respectively.The median overall survival (OS) time is 28.0 months, the 2- and 5-year OS rates are 57% and 19%, respectively. For stage III patients, median OS amounts to 24.3 months, 2- /5-year OS rates to 51% and 18%, respectively.2 treatment-related deaths (progressive pulmonary fibrosis) occurred in patients with pre-existing pulmonary fibrosis. Further acute and late toxicity was mild.ConclusionsThis novel approach yields a high level of locoregional tumor control and survival times. In general it is well tolerated. In all outcome parameters it seems to compare favourably with simultaneous chemo-radiotherapies, at present considered ‘state of the art’; and is additionally amenable for an unselected patient population.

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Amphotericin B Lozengers: Prophylaxis for Esophagitis in Thoracic Radiotherapy

Abstract: Prophylactic administration of amphotericin B lozengers seems to effectively prevent radiation-induced esophagitis.

Cited by 6 publications

References 27 publications

Radiation-induced oesophagitis in lung cancer patients

Radiation-induced oesophagitis in lung cancer patients

Clostridium difficile-associated diarrhea in radiooncology: an underestimated problem for the feasibility of the radiooncological treatment?

DART-bid (Dose-differentiated accelerated radiation therapy, 1.8 Gy twice daily)–a novel approach for non-resected NSCLC: final results of a prospective study, correlating radiation dose to tumor volume

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