Intermittent Use of Amifostine during Postoperative Radiochemotherapy and Acute Toxicity in Rectal Cancer Patients

Dunst, Jürgen; Semlin, S.; Pigorsch, Steffi; Müller, Arndt-Christian; Reese, Thomas J.

doi:10.1007/pl00002350

Cited by 50 publications

(44 citation statements)

References 12 publications

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“…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 .…”

Section: Resultsmentioning

confidence: 99%

“…Reasons for exclusion of patients from analysis included lack of compliance with the agent or dressing, withdrawal from the study, or failure to show up to clinic appointments. Skin reactions were often assessed by one evaluator, which was commonly a radiation oncologist, dermatologist, research nurse, research assistant, radiation therapist, principal investigator, or other medical professional 3,17,20,21,24,26,27,32,33,35,39,44,46,50 . A few studies incorporated an inter-rater reliability measure by having more than one evaluator assess the skin reactions 23,34,36,45,49,51 ; the remaining studies did not describe who assessed the radiated area or areas 2,16,19,25,28,30,31,38,[41][42][43]47,48 .…”

Section: Resultsmentioning

confidence: 99%

“…The second most common tool in use was the U.S. National Cancer Institute's Common Toxicity Criteria (nci ctc), which is similar to the rtog and was used in nine studies 2,3,26,28,30,[37][38][39]46 . The remaining studies used a study-designed tool closely modeled after either the rtog or nci tool, with slight variations [18][19][20]23,31,43,49 .…”

Section: Resultsmentioning

confidence: 99%

“…Amifostine: Amifostine is a thiol derivative that has demonstrated radioprotective effects in animal experiments 39 . One retrospective study 47 and one nonrandomized clinical trial 39 evaluated amifostine as a cytoprotective agent against acute radiationinduced skin reactions.…”

Section: Systemic Interventionsmentioning

confidence: 99%

“…Dunst et al 39 assessed the efficacy of amifostine in patients receiving radiochemotherapy for rectal cancer. The maximum grade of erythema was higher in patients who did not receive amifostine (1.46 ± 0.64 vs. 0.87 ± 0.52, p = 0.009).…”

Section: Systemic Interventionsmentioning

confidence: 99%

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

et al. 2010

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Radiation therapy is a common treatment for cancer patients. One of the most common side effects of radiation is acute skin reaction (radiation dermatitis) that ranges from a mild rash to severe ulceration. Approximately 85% of patients treated with radiation therapy will experience a moderate-to-severe skin reaction. Acute radiation-induced skin reactions often lead to itching and pain, delays in treatment, and diminished aesthetic appearance-and subsequently to a decrease in quality of life.Surveys have demonstrated that a wide variety of topical, oral, and intravenous agents are used to prevent or to treat radiation-induced skin reactions. We conducted a literature review to identify trials that investigated products for the prophylaxis and management of acute radiation dermatitis. Thirty-nine studies met the pre-defined criteria, with thirty-three being categorized as prophylactic trials and six as management trials.For objective evaluation of skin reactions, the Radiation Therapy Oncology Group criteria and the U.S. National Cancer Institute Common Toxicity Criteria were the most commonly used tools (65% of the studies). Topical corticosteroid agents were found to significantly reduce the severity of skin reactions; however, the trials of corticosteroids evaluated various agents, and no clear indication about a preferred corticosteroid has emerged. Amifostine and oral enzymes were somewhat effective in preventing radiation-induced skin reactions in phase ii and phase iii trials respectively; further large randomized controlled trials should be undertaken to better investigate those products. Biafine cream (Ortho-McNeil Pharmaceuticals, Titusville, NJ, U.S.A.) was found not to be superior to standard regimes in the prevention of radiation-induced skin reactions (n = 6).In conclusion, the evidence is insufficient to support the use of a particular agent for the prevention and management of acute radiation-induced skin reactions. Future trials should focus on comparing agents and approaches that, in phase i and ii trials, suggest efficacy. These future phase iii randomized controlled trials must clearly distinguish between preventive and management strategies for radiation-induced dermatitis. Only then can evidence-based guidelines be developed, with the hope of standardizing the approach across centres and of improving the prevention and management of radiation-induced dermatitis.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Systemic Interventionsmentioning

confidence: 99%

Section: Systemic Interventionsmentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2010

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Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers

Lawrie

Green

Beresford

et al. 2018

Cochrane Database of Systematic Reviews

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Conformal radiotherapy techniques are an improvement on older radiotherapy techniques. IMRT may be better than 3DCRT in terms of GI toxicity, but the evidence to support this is uncertain. There is no high-quality evidence to support the use of any other prophylactic intervention evaluated. However, evidence on some potential interventions shows that they probably have no role to play in reducing RT-related GI toxicity. More RCTs are needed for interventions with limited evidence suggesting potential benefits.

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National Cancer Institute (NCI) state of the science: Targeted radiosensitizers in colorectal cancer

George

Franke

Chakravarthy

et al. 2019

Cancer

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Colorectal cancer (CRC) represents a major public health problem as the second leading cause of cancer‐related mortality in the United States. Of an estimated 140,000 newly diagnosed CRC cases in 2018, roughly one‐third of these patients will have a primary tumor located in the distal large bowel or rectum. The current standard‐of‐care approach includes curative‐intent surgery, often after preoperative (neoadjuvant) radiotherapy (RT), to increase rates of tumor down‐staging, clinical and pathologic response, as well as improving surgical resection quality. However, despite advancements in surgical techniques, as well as sharpened precision of dosimetry offered by contemporary RT delivery platforms, the oncology community continues to face challenges related to disease relapse. Ongoing investigations are aimed at testing novel radiosensitizing agents and treatments that might exploit the systemic antitumor effects of RT using immunotherapies. If successful, these treatments may usher in a new curative paradigm for rectal cancers, such that surgical interventions may be avoided. Importantly, this disease offers an opportunity to correlate matched paired biopsies, radiographic response, and molecular mechanisms of treatment sensitivity and resistance with clinical outcomes. Herein, the authors highlight the available evidence from preclinical models and early‐phase studies, with an emphasis on promising developmental therapeutics undergoing prospective validation in larger scale clinical trials. This review by the National Cancer Institute's Radiation Research Program Colorectal Cancer Working Group provides an updated, comprehensive examination of the continuously evolving state of the science regarding radiosensitizer drug development in the curative treatment of CRC.

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Intermittent Use of Amifostine during Postoperative Radiochemotherapy and Acute Toxicity in Rectal Cancer Patients

Cited by 50 publications

References 12 publications

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

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

Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers

National Cancer Institute (NCI) state of the science: Targeted radiosensitizers in colorectal cancer

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