Serious adverse effects of amifostine during radiotherapy in head and neck cancer patients.
OBJECTIVE
Amifostine has been shown to protect against xerostomia induced by radiotherapy for head and neck cancer, but its impact on the therapeutic index is unknown. This is the first report focusing on amifostine related adverse effects leading to discontinuation of amifostine treatment.


METHODS
Thirty-nine patients from two centers irradiated for head and neck cancer received i.v.-infusions of amifostine prior to each radiation fraction. In a phase III study, two daily amifostine doses, 200 mg/m(2) (n = 21) and 340 mg/m(2) (n = 18), were compared for protection against radiation induced toxicity. Total radiation dose was 60-70Gy (2Gy per fraction), nine patients received concurrent chemotherapy with cisplatin/5-FU. amifostine was usually discontinued after >1 episode of serious toxicity during subsequent treatment sessions.


RESULTS
In 16/39 patients (41%) amifostine was discontinued due to severe adverse effects, which led to discontinuation of the phase III study. In four of 16 patients radiotherapy was delayed due to amifostine related adverse effects for 1-3 days. Discontinuation occurred more often in patients receiving chemotherapy. The results led to a literature review for amifostine treatment during radiotherapy in head and neck cancer patients. Regarding our series and published series using an amifostine schedule comparable to ours, total discontinuation rate was 27% (57/214). Discontinuation was significantly influenced by chemotherapy (P = 0.007) but not by amifostine dose (P = 0.156).


CONCLUSIONS
Daily i.v. administration of amifostine during radiotherapy in head and neck cancer is associated with a high rate of serious adverse effects leading to discontinuation of amifostine treatment and sometimes delay of radiotherapy.
Rades
Dirk
D
Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, Hamburg D-20246, Germany.
Fehlauer
Fabian
F
Bajrovic
Amira
A
Mahlmann
Birgit
B
Richter
Eckart
E
Alberti
Winfried
W
D000328:Adult; D000368:Aged; D004999:Amifostine / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D004342:Drug Hypersensitivity / Q000209:etiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000528:radiation effects; D011832:Radiation Injuries / Q000517:prevention & control; D011837:Radiation-Protective Agents / Q000009:adverse effects*; D013280:Stomatitis / Q000517:prevention & control; D014839:Vomiting / Q000139:chemically induced; D014987:Xerostomia / Q000517:prevention & control
D011837:Radiation-Protective Agents; D004999:Amifostine