Singh Anurag K, Ménard Cynthia, Guion Peter, Simone Nicole L, Smith Sharon, Crouse Nancy Sears, Godette Denise J, Cooley-Zgela Theresa, Sciuto Linda C, Coleman Jonathan, Pinto Peter, Albert Paul S, Camphausen Kevin, Coleman C Norman
Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.
Int J Radiat Oncol Biol Phys. 2006 Jul 15;65(4):1008-13. doi: 10.1016/j.ijrobp.2006.02.030. Epub 2006 May 26.
Our goal was to test the ability of intrarectal amifostine to limit symptoms of radiation proctitis.
The first 18 patients received 1 g of intrarectal amifostine suspension placed 30-45 min before each radiation treatment. The following 12 patients received 2 g of amifostine. Total dose prescribed ranged from 66 to 76 Gy. All patients were treated with three-dimensional conformal radiation therapy. The suspension remained intrarectal during treatment and was expelled after treatment. For gastrointestinal symptoms, during treatment and follow-up, all patients had a Radiation Therapy Oncology Group (RTOG) grade recorded.
Median follow-up was 18 months (range, 6-24 months). With 2 g vs. 1 g amifostine, there was a nearly significant decrease in RTOG Grade 2 acute rectal toxicity. Seven weeks after the start of radiation therapy, the incidence of Grade 2 toxicity was 33% in the 1-g group (6/18) compared with 0% (0/12) in the 2-g group (p=0.06). No Grade 3 toxicity or greater occurred in this study.
This trial suggests greater rectal radioprotection from acute effects with 2 g vs. 1 g amifostine suspension. Further studies should be conducted in populations at higher risk for developing symptomatic acute and late proctitis.
我们的目标是测试直肠内给予氨磷汀限制放射性直肠炎症状的能力。
前18例患者在每次放疗前30 - 45分钟接受1克直肠内氨磷汀混悬液。随后的12例患者接受2克氨磷汀。规定的总剂量范围为66至76 Gy。所有患者均接受三维适形放射治疗。混悬液在治疗期间保留在直肠内，治疗后排出。对于胃肠道症状，在治疗和随访期间，所有患者均记录了放射治疗肿瘤学组（RTOG）分级。
中位随访时间为18个月（范围6 - 24个月）。与1克氨磷汀相比，2克氨磷汀组RTOG 2级急性直肠毒性有近乎显著的降低。放疗开始7周后，1克组2级毒性发生率为33%（6/18），而2克组为0%（0/12）（p = 0.06）。本研究中未发生3级或更高级别的毒性。
该试验表明，与1克氨磷汀混悬液相比，2克氨磷汀混悬液对直肠的急性效应具有更强的放射防护作用。应在发生有症状的急性和晚期直肠炎风险较高的人群中进行进一步研究。
