Prevention of Radiochemotherapy-Induced Esophagitis With Glutamine: Results of a Pilot Study

Algara, Manuel; Rodríguez, Núria; Viñals, P.; Lacruz, M.; Arnalot, Palmira Foro; Reig, A.; Quera, J.; Lozano, J.; Fernández-Velilla, Enric; Membrive, I.; Dengra, J.; Sanz, X.

doi:10.1016/j.ijrobp.2007.03.041

Cited by 50 publications

(43 citation statements)

References 45 publications

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“…It should be noted that, in our series, the onset of ≥ grade 2 esophagitis was delayed in the study group (when compared to the control group), occurring only at higher doses of radiation, during the 5th week of treatment (41.8 vs. 25.4 Gy; p < 0.001). Similar to our study, Algara et al [30] found that the highest grade of esophagitis occurred at week 6 of treatment in patients assuming glutamine supplementation, with an overall incidence of 32.7% for grade 2 and 6.1% for grade 3 acute esophagitis.…”

Section: Discussionsupporting

confidence: 91%

Efficacy of a Propolis-Based Syrup (FARINGEL) in Preventing Radiation-Induced Esophagitis in Locally Advanced Lung Cancer

Ippolito¹,

Floreno²,

Rinaldi³

et al. 2018

Chemotherapy

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Aim: To evaluate the efficacy of a propolis-based syrup, FARINGEL®, in preventing radiation-induced esophagitis in locally advanced lung cancer patients. Methods. Patients were treated with concurrent chemoradiotherapy (CRT) using involved-field radiotherapy (RT). Every patient received FARINGEL at the beginning of CRT until the first follow-up. The data of the study group were compared with the data of a control group treated without the administration of the syrup. Results: Forty-five patients were enrolled. Forty-one (91.1%) completed the protocol and were evaluable for esophagitis. Grade ≥2 toxicity occurred in 9/41 patients (22%). No differences in overall toxicity were detected between the study group and the control group (n = 55, 60.9 vs. 54.5%; p = ns). Grade 2–3 esophagitis was lower in the study group in comparison with the control group (22 and 38%, respectively), but statistical significance was not reached (p = 0.09). However, the onset of grade ≥2 esophagitis was delayed in the study group compared to the control group, occurring at higher doses of RT (41.8 vs. 25.4 Gy; p < 0.001). Furthermore, the mean number of interruption days for esophagitis was lower in the study group than in the control group (0.6 ± 2.0 vs. 2.1 ± 3.6; p = 0.025). Conclusion: FARINGEL was well-tolerated and delayed esophagitis that was induced by CRT for locally advanced lung cancer.

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Section: Discussionsupporting

confidence: 91%

Efficacy of a Propolis-Based Syrup (FARINGEL) in Preventing Radiation-Induced Esophagitis in Locally Advanced Lung Cancer

Ippolito¹,

Floreno²,

Rinaldi³

et al. 2018

Chemotherapy

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“…In human patients receiving pelvic RT, plasma levels of the amino acid metabolite citrulline have been correlated to intestinal toxicity (21). Finally, supplementation with glutamine, an amino acid metabolite, has been associated with decreased rates of high-grade esophagitis in patients receiving RT for lung cancer (22,23). Taken together, these studies suggest a possible association between metabolites and RT toxicity.…”

Section: Figure 1 Graph Of Individual Metabolites Most Important Formentioning

confidence: 99%

Plasma Metabolites and Risk of Radiation-induced Esophagitis: A Secondary Analysis from a Prospective Study

Tandberg

Holt

Kelsey

2017

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Abstract. Aim: Metabolic profiling was performed on plasma samples obtained prior to and during radiation therapy (RT) for locally advanced lung cancer to identify metabolites predictive of RT-induced esophagitis. Patients and Methods: Patients received cisplatin/etoposide with RT as part of a prospective dose-escalation study (n=24The most effective treatment approach for locally advanced lung cancer, whether non-small cell (NSCLC) or small cell, is concurrent chemotherapy and radiation therapy (RT). RTinduced esophagitis is a primary dose-limiting acute toxicity of concurrent chemotherapy and RT. Severe esophagitis can result in significant morbidity during treatment and inferior clinical outcomes (1, 2).Numerous clinical and dosimetric factors have been associated with increasing risk of RT-induced esophagitis. Clinical factors include nodal stage of N2 or worse, hyperfractioned RT, pre-existing dysphagia, and concurrent chemotherapy (3, 4). Dosimetric factors include increasing mean esophagus dose, maximum esophageal dose, as well as a wide range of volumetric parameters [e.g. esophageal volume receiving >35 Gy (V35), V45, V50, and V60] (3-6). However, a single best threshold volumetric predictor of high-grade esophagitis has not been identified (6). Thus, there is a need for alternative predictors of esophagitis, such as biological biomarkers, to assist in the accurate prediction of esophagitis. By identifying patients at increased risk of high-grade RT-induced esophagitis, modifications in RT technique (e.g. intensity-modulated RT, image guidance) or aggressive and early supportive care could be utilized to minimize the risk of, or complications from, esophagitis.Metabolomics refers to the identification and study of small-molecule chemicals which are the end-products of cellular processes. Alterations in genetic, transcriptional, and proteomic processes, as well as lifestyle/environmental changes can result in changes in the metabolome. There is interest in utilizing metabolomics to identify biomarkers predictive of RT response and toxicity (7). Indeed, studies in mice have identified metabolites correlated with RT-induced damage to the intestinal tract and lung (8, 9). To our knowledge, evaluation of metabolites predictive of RTinduced esophagitis has not been reported in a human population. Thus, we performed metabolic profiling of prospectively collected plasma samples from patients receiving concurrent chemotherapy and RT for locally advanced lung cancer to determine if concentration differences of single metabolites or panels of metabolites could be predictive of high-grade RT-induced esophagitis. Patients and MethodsAs part of an Institutional Review Board-approved prospective clinical trial (Clinicaltrials.gov identifier NCT00921739), patients with locally advanced lung cancer were treated with escalating doses of accelerated RT with concurrent chemotherapy (10).

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“…In patients with mild to moderate swallowing difficulty, semisolid nutrition and liquid form analgesics may be beneficial. Although confirmation with randomized controlled Phase 3 trials are needed, based on the results of two recent retrospective series by Algara et al and Topkan et al, prophylactic use of glutamine may be beneficial in preventing and reducing the severity of acute esophagitis (Algara, 2007;Topkan, 2009). Nonproductive dry cough may be seen if trachea and/or major bronchi is/are involved in the high dose radiation portals.…”

Section: Treatment Related Toxicitymentioning

confidence: 99%

Radiation Therapy in Management of Small-Cell Lung Cancer

Topkan¹,

Parlak²

2012

Lung Diseases - Selected State of the Art Reviews

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Prevention of Radiochemotherapy-Induced Esophagitis With Glutamine: Results of a Pilot Study

Cited by 50 publications

References 45 publications

Efficacy of a Propolis-Based Syrup (FARINGEL) in Preventing Radiation-Induced Esophagitis in Locally Advanced Lung Cancer

Efficacy of a Propolis-Based Syrup (FARINGEL) in Preventing Radiation-Induced Esophagitis in Locally Advanced Lung Cancer

Plasma Metabolites and Risk of Radiation-induced Esophagitis: A Secondary Analysis from a Prospective Study

Radiation Therapy in Management of Small-Cell Lung Cancer

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