The Effect of Amifostine on Acute and Late Radiation Side Effects in Head and Neck Cancer Patients

Abstract

A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : We aimed to investigate the effect of amifostine on acute and late side effects, and its tolerability in head and neck cancer patients treated with radiotherapy (RT). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : The study included 87 patients with primary head and neck cancers and cervical lymph node metastases from unknown primary cancers treated with RT alone or combined with chemotherapy (CT). Forty-one patients (47%) received amifostine combined with RT (ART group) and 46 patients (52%) received RT without amifostine (RT group). The patients were evaluated every week during the treatment and at month 1 and 2 after the completion of RT for acute side effects and month 3, 6, 9, 12, and 24 after the treatment for late side effects according to SOMA/LENT scale. Amifostine was administered prior to RT, along with anti-emetic prophylaxis. The two groups were compared with the Student's t and MannWhitney U and Chi-square tests. R Re es su ul lt ts s: : The ART group had significantly less toxicity (grade 1 mucositis, grade 2 fibrosis) than patients in the RT group (p=0.001, p=0.03, respectively). At week 3 of RT grade 2 mucositis developed in two patients (5%) in the ART group and 10 patients (22%) in the RT group (p=0.02). The protective effect of amifostine on skin reactions developed at week 4 of RT (p=0.05). Grade 3 xerostomia at 9, 12, and 15 months of follow-up (p=0.02, p=0.02, and p=0.02, respectively), grade 2 xerostomia at 18 and 24 months (p=0.02 and p=0.01, respectively) and fibrosis at 15, 18 and 24 months (p=0.05, p=0.02 and p=0.02, respectively) decreased markedly in the ART group compared with the RT group. Emesis was the most common adverse effect of amifostine. C Co on nc cl lu us si io on n: : Daily administration of amifostine during RT was effective in avoiding late grade 2-3 xerostomia, as well as grade 2 fibrosis. K Ke ey y W Wo or rd ds s: : Radiotherapy; head and neck cancer; amifostine; xerostomia Ö ÖZ ZE ET T A Am ma aç ç: : Amifostinin radyoterapi (RT) ile tedavi edilmiş baş ve boyun kanseri hastalarında akut ve geç yan etkiler üzerindeki etkisini ve tolerabilitesini araştırmayı amaçladık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmaya, tek başına RT veya RT ve eş zamanlı kemoterapi (KT) ile tedavi edilmiş primer baş ve boyun kanseri olan ve primeri bilinmeyen bir kanserden servikal lenf düğümlerine metastaz yapmış 87 hasta dâhil edildi. Kırk bir hastaya (47%) RT ile birlikte amifostin (ART grup) ve 46 hastaya (52%) amifostin olmaksızın RT (RT grubu) verildi. Olgular, tedavi sırasında akut yan etkiler açısından her hafta ve RT bittikten sonra 1. ve 2. ayda, geç yan etkiler açısından ise tedavi bittikten sonra 3., 6., 9., 12., ve 24. aylarda SOMA/LENT skalasına göre değerlendirildiler. Amifostin RT'den önce antiemetik profilaksi ile beraber uygulandı. İki grubun, komplikasyonlar üzerindeki etki açısından karşılaştırılmasında Student-t ve Mann Whitney-u testleri kullanıldı. B Bu ul lg gu ul la ar r: : AR...