Cytoprotective Effect of Amifostine in Radiation-Induced Acute Mucositis – a Retrospective Analysis

Abstract

Purpose: To study the cytoprotective impact of amifostine against acute radiation mucositis. Patients and Methods: A total of 117 cancer patients with carcinomas localized in pelvic organs, lung and head and neck were entered into this study. In a retrospective way, and in order to minimize the bias related to the investigator, 138 patients as historical controls were randomly selected from a database in our hospital. Acute radiation-induced gastrointestinal mucositis, esophagitis and stomatitis were assessed using the common toxicity criteria scale. The most severe grade recorded was evaluated as the final morbidity score for this patient. Mean toxicity score (MTS) was the mean value of recorded acute radiation toxicity. Mean interruption time (MIT) was the mean value of recorded interruption time due to radiation toxicity. Results: A significantly reduced severity of symptomatology related to oral, esophageal and rectal mucosa was noted in the amifostine group (group A) (p < 0.05, chi-square test). Furthermore, a significant reduction of MTS as well as MIT was observed in group A versus the historical controls (group B) (p < 0.05, Mann-Whitney U test). Conclusion: The administration of amifostine seems to protect patients against radiation-induced mucositis, but further investigation with randomized trials is needed.

Radiotherapy and wound healing: Principles, management and prospects (Review)

“…protection against radiation-induced dermatitis was analyzed retrospectively in patients with pelvic tumors who were treated with radiotherapy. the studies showed hopeful results (88).…”

Prophylaxis and Management of Acute Radiation-Induced Skin Reactions: A Systematic Review of the Literature

“…Twenty-six of the preventive trials were rcts 2,16-25, 27-32,34-37, [41][42][43][44]46 , six were nonrandomized clinical trials 3,26,33,38,39,45 , and one was a retrospective trial 40 . Twenty-one of the trials were open 3,16,19,20,24-26, 28,29,32-35,37-43,45 , three were single-blind 17,22,27 , and nine were double-blind 2,18,21,23,30,31,36,44,46 .…”

“…The data gathered for six of the included trials were limited because only abstracts were available 22,25,29,37,40,52 . Of the thirty-three studies from which additional information was gathered, six trials analyzed patients by intention to treat 16,17,30,32,35,50 , and twenty-seven assessed only evaluable patients 2,3,18-21, 23,24,26-28,31,33,34,36,38-44,46-49,51 .…”

“…Grade 3 and 4 reactions, evaluated using the Subjective Objective Management Analytic (soma) grading system, were significantly fewer in the gm-csf group (p = 0.014). Kouvaris and colleagues also found that the time interval of treatment interruption was significantly shorter in patients who received the gm-csf (5.17 ± 1.76 days vs. 6.57 ± 2.30 days, p = 0.037) and that pain relief occurred significantly sooner after gm-csf application (3.12 ± 1.42 days vs. 5.48 ± 1.59 days, p = 0.0017) 40 . This study used a "sum of gross dermatitis score" that was evaluated by adding the dermatitis score (rtog criteria) to the pain score (soma grading system).…”

“…One nonrandomized open study by Kouvaris et al 40 compared use of betamethasone alone with the use of gauze impregnated with a granulocyte-macrophage colony-stimulating factor (gm-csf) in addition to betamethasone. The authors found that the grades of skin reaction were significantly lower (p = 0.008) and the healing time significantly shorter (p = 0.02) in the gm-csf group.…”