Oral Glutamine Supplementation Reduces Radiotherapy-induced Esophagitis in Lung Cancer Patients

Abstract

Background: The purpose of this study was to assess the the efficacy of oral glutamine (GLN) in prevention of acute radiation-induced esophagitis in patients with lung cancer and determine the predictive role of clinical and dosimetric parameters. Materials and Methods: Thirty-two patients diagnosed with lung cancer were studied prospectively. Sixteen patients (50%) received prophylactic powdered GLN orally in doses of 10g/8h. Patients were treated 2 Gy per fraction daily, 5 days a week. We evaluated the grading of esophagitis daily at the end of each fraction of each treatment day until a cumulative dose of 50 Gy was reached. The primary end point was radiation-induced esophagitis. Results: All patients tolerated GLN well. Toxicity grade, weight loss, serum cytokine levels and esophageal transit times exhibited statistically significant improvement in the GLN receiving group. GLN suppressed the inflammation related to the disease and treatment and reduced toxicity with statistical significance. Conclusions: This study suggests a benefical role of oral GLN use in prevention and/or delay of radiation-induced esophagitis, in terms of esophageal transit time and serum immunological parameters, as well as weight loss.

Research and Development of Radioprotective Agents: A Mini-Review

“…For examples, glutamine, a non-essential amino acid was widely studied for its potential protective effect on mucositis, dermatitis and oespahagitis [114][115][116][117] ; pentoxifyline, a methyl xanthine derivative, decreased the risk of radiation toxicity in lung [118] ; benzydamine could prevent and treat oral mucositis [119] ; and sulfasalazine was evaluated for its effects on radiotherapy-induced enteritis [120] . To date, there are still a limited number of chemical RAs clinically used to minimize the severity and duration of toxicities associated with radiotherapy.…”

Oral Glutamine in Preventing Treatment‐Related Mucositis in Adult Patients With Cancer

“…The cancer type was different in various studies: 4 studies in lung cancer, 7,[19][20][21] 3 in breast cancer, 5,22,23 3 in head and neck cancer, [24][25][26] 1 with GI cancers, 27 1 with hematologic malignancies, 28 1 with multiple solid tumors, 29 1 with various types of cancers, 30 and 1 study without a defined cancer type. 31 Ten articles were prospective, 5,21,[23][24][25][27][28][29][30][31] and 5 were retrospective studies. 7,19,20,22,26 Anticancer treatment modality included chemotherapy only, 5,22,23,27,[29][30][31] radiation only, 19,24,28 and their combination.…”

“…7,19,20,22,26 Anticancer treatment modality included chemotherapy only, 5,22,23,27,[29][30][31] radiation only, 19,24,28 and their combination. 7,20,21,25,26 Ten studies evaluated oral mucositis (stomatitis) only, 5,[22][23][24][25][27][28][29][30][31] 4 studied esophageal mucositis only, 7,[19][20][21] and 1 evaluated both. 26 Three of the trials were designed as crossover studies, 5,27,30 while the remaining 12 used a parallel group design.…”

“…26 Three of the trials were designed as crossover studies, 5,27,30 while the remaining 12 used a parallel group design. 7,[19][20][21][22][23][24][25][26]28,29,31 The smallest study evaluated 21 patients, 22 and the largest evaluated 326 patients. 5 Based on a significant reduction in the maximum grade, duration, and/or time of onset of mucositis evident in the glutamine group summarized in Table 3 and/or 4 and/or based on the author's conclusion.…”

Comparative Real Time EPR Investigation of Natural and Synthetic Antioxidants: As Potential Anticancer Agents and Radio-protectors

“…Moreover, some of these nitrosoureas showed higher anti-leukemic and anti-melanomic effect and better immune-modulatory properties, as compared to non-labeled CCNU 17 . To reduce oxidative stress negative consequences, induced by radiation or chemotherapy, a number of microbial/ phyto materials and synthetic antioxidants have been successfully utilised [18][19][20][21] . Various combinations can reduce the levels of oxidative stress biomarkers and cause protective efficacy 22, due to their multi-plant content or chemically-isolated constituents.…”