Sulindac Therapy of Colorectal Polyps in Familial Adenomatous Polyposis

Tonelli, Francesco; Valanzano, Rosa; Dolara, Piero

doi:10.1159/000171461

Cited by 18 publications

(4 citation statements)

References 27 publications

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“…The treatment was usually well tolerated, and regression of the polyps was frequently observed. Randomized double-blind, placebo-controlled studies showed a statistically significant decrease in the number and size of polyps after a few months of therapy [26], although with long-term treatment a proliferation of new polyps and cancer can occur [27,28]. Our intention was to use Sulindac treatment with IRA to decrease or avoid adenomas in the rectal stump.…”

Section: Discussionmentioning

confidence: 99%

Restorative Proctocolectomy or Rectum‐Preserving Surgery in Patients with Familial Adenomatous Polyposis: Results of a Prospective Study

Tonelli¹,

Valanzano²,

Monaci³

et al. 1997

World j. surg.

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Surgical treatment of familial adenomatous polyposis (FAP) is still controversial. From 1984 we carried out a prospective evaluation of total colectomy with ileorectal anastomosis (IRA) and restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) to determine differences in postoperative complications, functional results, occurrence of desmoids, and recurrence of polyps in the rectal stump. IRA was performed below the peritoneal reflection and was indicated in the absence of rectal cancer and in the presence of fewer than 10 polyps or minute polyposis in the last 10 cm of the rectal mucosa. IRA patients underwent a regular endoscopic follow-up and prolonged sulindac administration (100 mg twice daily). When criteria for IRA were absent, IPAA was performed adopting a manual anastomosis at the pectinate line. Fourteen patients were operated with IRA and 24 with IPAA. There was no difference in sex and age between the two groups of patients. The number of rectal polyps was significantly different in the two groups. Immediate postoperative complications were observed in only five IPAA patients, three of whom (12%) required reoperation. Late postoperative complications occurred more frequently in IRA patients (14%) than in IPAA patients (4%). Desmoids developed in both groups (five in the IRA group and four in IPAA group). The number of bowel movements was similar in both groups, but 25% of IPAA patients complained of nocturnal fecal soiling. Fulguration or polypectomy for recurrent polyps was necessary in all but two IRA patients at follow-up. The rectal stump was easily eradicated by polyps in all but four patients with minute polyps at surgery. In the latter patients a diffuse or carpeting rectal polyposis occurred. IPAA can give optimum control of colorectal polyposis in FAP patients with an acceptable incidence of postoperative complications and satisfactory functional results. This type of surgical procedure is indicated in most FAP patients, and IRA should be reserved for patients without polyps or with fewer than 10 polyps in the rectal stump; otherwise growth of polyps cannot be adequately controlled.

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Section: Discussionmentioning

confidence: 99%

Restorative Proctocolectomy or Rectum‐Preserving Surgery in Patients with Familial Adenomatous Polyposis: Results of a Prospective Study

Tonelli¹,

Valanzano²,

Monaci³

et al. 1997

World j. surg.

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“…These are precursor lesions of large bowel cancer in people with familial adenomatous polyposis (FAP) [24,25]. Lovastatin (4), 2-methylbutanoic acid 1,2,3,7,8,8a-hexahydro-3,7-dimethyl-8-[2-(tetrahydro-4-hydroxy-6-oxo-2H-pyran-2-yl)ethyl]-1-naphthalenyl ester (Mevacor®) was one of the original HRIs used to reduce serum cholesterol levels in people with coronary artery disease.…”

Section: Sulindac With Lovastatinmentioning

confidence: 99%

A Review of Cancer Chemopreventive Agents

Levi¹,

Borne²,

Williamson³

2001

CMC

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In the late 20(th) century, the treatment of cancer began to include its prevention. Today, compounds exist that will lower the risk of developing certain types of cancer. This has been demonstrated in studies where chemically induced tumor growth has been slowed or reversed. Anti-inflammatory compounds having chemopreventive activity are piroxicam, sulindac, aspirin, celecoxib and curcumin. The selective estrogen receptor modulators, tamoxifen and raloxifene, are beneficial in the prevention of estrogen dependent tumors. Retinoids, vitamin A derivatives, such as targretin and fenretinide are useful in the prevention of tumors. Compounds containing sulfur, such as sulforaphane and oltipraz, are even useful as radioprotective agents. The steroid dehydroepiandosterone can inhibit experimental carcinogenesis. All of these chemical classes provide a start for the medicinal chemist to design more effective chemopreventive agents. The biomarkers used to determine the chemopreventive activity of new compounds are quite often activities of enzymes. The identification of those individuals at high risk is still in its infancy and presents a troubling dilemma.

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“…At least four reports have documented incident cancer cases occurring among FAP patients while on sulindac. 95,57,61,68,91 In the most recent example, Giardiello et al 68 described an FAP patient treated with sulindac for 35 months who developed an ulcerating, flat rectal adenocarcinoma in the absence of neighboring polyps. Such cases highlight the fact that an accurate estimate of long-term colorectal cancer risk reduction from sulindac in individuals with FAP cannot currently be made.…”

Section: Potential Limitations Of Chemoprevention In Hereditary Colormentioning

confidence: 99%