Prevention of radiochemotherapy-induced esophagitis with glutamine: results of a pilot study.
OBJECTIVE
To assess the usefulness of oral glutamine to prevent radiochemotherapy-induced esophagitis in patients with lung cancer, and to determine the dosimetric parameter predictive of esophagitis.


METHODS
Seventy-five patients were enrolled; 34.7% received sequential radiochemotherapy, and 65.3% received concomitant radiochemotherapy. Every patient received prophylactic glutamine powder in doses of 10 g/8 h. Prescribed radiation doses were 45-50 Gy to planning target volume (PTV)1 (gross tumor volume plus wide margins) and 65-70 Gy to PTV2 (reduced margins). The primary endpoint was the incidence of Grade 2 or greater acute esophagitis.


RESULTS
No patient experienced glutamine intolerance or glutamine-related toxicity. Seventy-three percent of patients who received sequential chemotherapy and 49% of those who received concomitant chemotherapy did not present any form of esophagitis. V50 was the dosimetric parameter with better correlation between esophagitis and its duration. A V50 of <or=30% had a 22% risk of esophagitis Grade >or=2, which increased to 71% with a V50 of >30% (p = 0.0009).


CONCLUSIONS
The use of oral glutamine may have an important role in the prevention of esophageal complications of concomitant radiochemotherapy in lung cancer patients. However, randomized trials are needed to corroborate that effect. V50 is the dosimetric parameter with better correlation with esophagitis grade and duration.
Algara
Manuel
M
Department of Radiation Oncology, Hospital de l'Esperança, Institut Municipal d'Assistència Sanitaria (IMAS), Barcelona, Spain. malgara@imas.imim.es
Rodríguez
Nuria
N
Viñals
Pedro
P
Lacruz
Martí
M
Foro
Palmira
P
Reig
Anna
A
Quera
Jaume
J
Lozano
Joan
J
Fernández-Velilla
Enric
E
Membrive
Ismael
I
Dengra
Josefa
J
Sanz
Xavier
X
D000208:Acute Disease; D000284:Administration, Oral; D000368:Aged; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D004941:Esophagitis / Q000209:etiology / Q000517:prevention & control*; D004947:Esophagus / Q000187:drug effects / Q000528:radiation effects; D005240:Feasibility Studies; D005260:Female; D005973:Glutamine / Q000008:administration & dosage*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011832:Radiation Injuries / Q000517:prevention & control; D011837:Radiation-Protective Agents / Q000008:administration & dosage*; D011879:Radiotherapy Dosage
D011837:Radiation-Protective Agents; D005973:Glutamine