Effect of pentoxifylline and tocopherol on radiation proctitis/enteritis.
OBJECTIVE
Chronic radiation proctitis/enteritis is a relevant complication of pelvic irradiation, which is still mainly treated by supportive measures only. There is some evidence that the combined treatment with pentoxifylline and tocopherol might alter the pathogenesis of radiation-induced fibrosis. In a retrospective analysis the clinical benefit of the treatment with pentoxifylline/tocopherol on radiation-induced proctitis/enteritis was evaluated, compared to supportive care only.


METHODS
Of 30 patients with radiation-induced proctitis/enteritis grade I-II according to the RTOG/EORTC toxicity criteria, 21 were treated with pentoxifylline and tocopherol. Depending on physician's decision nine patients received symptomatic treatment only.


RESULTS
With pentoxifylline/tocopherol treatment 15/21 patients (71%) experienced a relief of their symptoms. A reduction from grade I/II to grade 0 toxicity was observed in seven and from grade II to grade I toxicity in eight patients. No improvement was seen in six patients. The median time to improvement with pentoxifylline and tocopherol treatment was 28 weeks. In three of nine patients who were treated supportively only, deterioration of symptoms occurred. Three patients experienced no amelioration, and three patients with grade I toxicity experienced a spontaneous relief of their symptoms (33%).


CONCLUSIONS
The combination treatment with pentoxifylline and tocopherol seems to have a benefit in patients with grade I-II radiation-induced proctitis/enteritis. The optimal schedule of treatment duration is not yet clear. From the observations made in this study it is assumed the treatment should be given for 6-12 months at least. A prospective phase II study should be undertaken to evaluate optimal treatment duration.
Hille
Andrea
A
Department of Radiotherapy and Radiation Oncology, University of Goettingen, Germany. ahille@med.uni-goettingen.de
Christiansen
Hans
H
Pradier
Olivier
O
Hermann
Robert Michael
RM
Siekmeyer
Birgit
B
Weiss
Elisabeth
E
Hilgers
Reinhard
R
Hess
Clemens F
CF
Schmidberger
Heinz
H
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000008:administration & dosage / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003627:Data Interpretation, Statistical; D004359:Drug Therapy, Combination; D016889:Endometrial Neoplasms / Q000532:radiotherapy; D004751:Enteritis / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010431:Pentoxifylline / Q000008:administration & dosage / Q000627:therapeutic use*; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011349:Proctitis / Q000188:drug therapy* / Q000209:etiology*; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011832:Radiation Injuries / Q000188:drug therapy*; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D012004:Rectal Neoplasms / Q000532:radiotherapy; D012189:Retrospective Studies; D013997:Time Factors; D024505:Tocopherols / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy; D014846:Vulvar Neoplasms / Q000532:radiotherapy
D000975:Antioxidants; D010726:Phosphodiesterase Inhibitors; D024505:Tocopherols; D010431:Pentoxifylline