Sodium butyrate enemas in the treatment of acute radiation-induced proctitis in patients with prostate cancer and the impact on late proctitis

Abstract

Purpose:To evaluate prospectively the effect of sodium butyrate enemas on the treatment of acute and the potential influence on late radiation-induced proctitis. Patients and Methods: 31 patients had been treated with sodium butyrate enemas for radiation-induced acute grade II proctitis which had developed after 40 Gy in median. During irradiation the toxicity was evaluated weekly by the Common Toxicity Criteria (CTC) and subsequently yearly by the RTOG (Radiation Therapy Oncology Group) and LENT-SOMA scale. Results: 23 of 31 patients (74%) experienced a decrease of CTC grade within 8 days on median. A statistical significant difference between the incidence and the severity of proctitis before start of treatment with sodium butyrate enemas compared to 14 days later and compared to the end of irradiation treatment course, respectively, was found. The median follow-up was 50 months. Twenty patients were recorded as suffering from no late proctitis symptom. Eleven patients suffered from grade I and 2 of these patients from grade II toxicity, too. No correlation was seen between the efficacy of butyrate enemas on acute proctitis and prevention or development of late toxicity, respectively. Conclusion: Sodium butyrate enemas are effective in the treatment of acute radiation-induced proctitis in patients with prostate cancer but have no impact on the incidence and severity of late proctitis. Natriumbutyrat-Einläufe in der Behandlung der akuten radiotherapieinduzierten Proktitis bei Patienten mit Prostatakarzinom und der Einfluss auf eine späte Proktitis. Eine prospektive UntersuchungZiel: Diese prospektive Untersuchung wurde durchgeführt, um den Effekt von Natriumbutyrat-Einläufen in der Therapie der akuten Proktitis sowie den potentiellen Einfluss auf radiogene rektale Spätreaktionen zu evaluieren. Patienten und Methodik: 31 Patienten wurden mit Natriumbutyrat-Einläufen bei radiogen induzierter akuter Grad-II-Proktitis behandelt, die im Mittel nach 40 Gy aufgetreten war. Während der Radiotherapie wurde die Toxizität wöchentlich anhand der Common Toxicity Criteria (CTC) und anschließend jährlich anhand der RTOG-und LENT-SOMA-Skalen erhoben. Ergebnisse: 23 von 31 Patienten (74%) erfuhren eine Abnahme des CTC-Grades innerhalb von 8 Tagen im Median. Dadurch war der Unterschied in der Häufigkeit und Schwere der Proktitis vor Therapiebeginn und 14 Tage später bzw. am Ende der Radiotherapie statistisch signifikant. Der mediane Follow-up lag bei 50 Monaten. 20 Patienten entwickelten keine späte Proktitis. 11 Patienten entwickelten eine Grad-I-und 2 von diesen Patienten ebenfalls eine Grad-II-Toxizität. Es konnte keine signifikante Korrelation zwischen der Effektivität der Natriumbutyrat-Einläufe und Prävention bzw. Entwicklung einer späten Toxizität entdeckt werden. Schlussfolgerung: Natriumbutyrat-Einläufe sind effektiv in der Behandlung der akuten radiotherapieinduzierten Proktitis bei Patienten mit Prostatakarzinom, haben aber keinen Einfluss auf die Häufigkeit und Schwere der späten Proktitis.Schlüsselwörter: Prostatakar...

Longitudinal Analysis of Quality of Life in Patients Receiving Conformal Radiation Therapy for Prostate Cancer

“…This is in line with clinical evidence and reports on acute urinary toxicity [7,22]. On the other hand, PR25 bowel symptoms did not increase significantly during CRT and were not elevated during follow-up which is not in accordance with clinical evidence and published reports on acute and chronic intestinal toxicity [3,8,10,11,13,17,20,22,31]. A reason for this discrepancy could lie in the four questions of the PR25 addressing bowel symptoms ("Have your daily activities been limited by bowel problems?…”

“…Since prostate cancer is often a slowly growing disease causing little or no symptoms, treatment toxicity and quality of life (QoL) are of major concern [5,7,8,10,13,23,24]. QoL might be directly influenced by the anticancer treatment or indirectly via the onset of treatment-related side effects.…”

Impact of the Target Volume (Prostate Alone vs. Prostate with Seminal Vesicles) and Fraction Dose (1.8 Gy vs. 2.0 Gy) on Quality of Life Changes After External-Beam Radiotherapy for Prostate Cancer

“…The inclusion of seminal vesicles in the CTV and the fraction dose are both very controversial aspects [7,10,15,16,36,37]. Dose-volume relationships for rectal toxicity are well known from the literature [1,2,4,6,9,12,23].…”

“…External-beam radiotherapy (EBRT) is a well-established curative treatment for prostate cancer [4,11,15,24,29]. Before treatment, the decision for a possible neoadjuvant (NHT) and/or adjuvant hormonal treatment, a suitable treatment technique, the target volume, single and total doses has to be made.…”

Hepatic Uptake of Rectally Administered Butyrate Prevents an Increase in Systemic Butyrate Concentrations in Humans1–3

“…In addition, butyrate alters the expression of signaling genes in the intestinal mucosa, thereby positively affecting mucosal immunity (7,8). The effects of prebiotics or colonic SCFA administration on the intestinal mucosa have been investigated in patients with a variety of intestinal diseases, such as ulcerative colitis, Crohn disease, pouchitis, diversion colitis, radiation proctitis, and irritable bowel syndrome (9)(10)(11)(12). Although results are not consistent, major evidence supports the concept that intestinal SCFA supplementation improves colonic disease (13)(14)(15)(16)(17)(18).…”