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Pentoxifylline and vitamin E combination improves superficial radiation-induced fibrosis
Proceedings of the 46th Annual ASTRO Meeting
2371
Pentoxifylline and Vitamin E Combination Improves Superficial Radiation-Induced Fibrosis
P. Haddad, B. Kalaghchi, F. Amouzegar-Hashemi Radiation Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Tehran, Iran Purpose/Objective: Radiation-induced fibrosis (RIF) remains a problematic chronic adverse effect of radiotherapy. Treatment of RIF with combined pentoxifylline (PTX) and vitamin E (vitE) has been suggested by the favorable results of recent animal and human studies. We evaluated this new treatment in a prospective “before and after” clinical trial. Materials/Methods: All patients with assessable skin and subcutaneous fibrosis in a previous radiotherapy field and no signs of tumor recurrence were eligible for this trial. After informed consent, patients received oral PTX 800 mg and vitE 1000 units per day for 3 months. The fibrotic lesion surface area and the grade of fibrosis (according to the objective grades of SOMA scale for skin and subcutaneous tissue) were recorded by 2 independent observers at 0, 1 and 3 months. A subgroup of consecutive patients from the study population received the medications for a further 3 months, with another evaluation at 6 months. Results: Thirty-seven patients entered the trial from June 2002 to April 2003, 8 of whom discontinued the medications within the first month (3 patients due to dizziness, 2 due to nausea, 1 due to swallowing difficulty from previous surgery and 2 due to reasons unrelated to treatment). Thus 29 patients presenting with 34 fibrotic lesions involving the skin and underlying tissues were treated. Patients were aged 10 –74 years with a mean age of 43 ⫾ 18 years and had a male-to-female ratio of 1.4. Previous radiation dose was 3000 – 6600 cGy with a mean of 5672 ⫾ 674 cGy and fraction size of 150 –250 cGy. Eighteen lesions were located in neck, 7 in breast, 5 in lower extremity, 2 in abdominal wall, 1 in pelvis and 1 in lower eyelid. All lesions exhibited continuous clinical regression and improvement with the therapy. The mean surface area of fibrosis for the 34 lesions was 112 ⫾ 81 cm2 at the time of study entry, 93 ⫾ 76 cm2 at 1 month (p ⬍ 0.001), and 65 ⫾ 48 cm2 at 3 months (p ⬍ 0.001). The mean grade of fibrosis was 2.32 ⫾ 0.7 at the study entry, 2.29 ⫾ 0.8 at 1 month (p ⫽ 0.3), and 2.00 ⫾ 0.8 at 3 months (p ⫽ 0.001). A subgroup of 18 patients with 21 fibrotic lesions received the medications for 6 months in total. In these lesions, the mean surface area decreased from 80 ⫾ 53 cm2 to 27 ⫾ 23 cm2 (p ⬍ 0.001) and the grade of fibrosis decreased from 2.24 ⫾ 0.8 to 1.43 ⫾ 0.7 (p ⬍ 0.001). Conclusions: PTX-vitE combination was mostly tolerated well; only 5 out of 37 patients discontinued the treatment because of side effects. It resulted in a significant reduction of fibrosis surface area and grade, more pronounced with 6 months of treatment. Our findings further confirm the efficacy of PTX-vitE combination in treatment of patients suffering from this disturbing late effect of radiotherapy.
2372
Salivary Gland Function in Patients with Differentiated Thyroid Cancer Treated with High Doses of Radioactive Iodine
A. Fard Esfahani, R. Olamie, M. Eftekhari, M. Saghari, B. Fallahi Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Tehran, Iran Purpose/Objective: Xerostomia is a well-recognized adverse effect of high-dose radioactive iodine treatment. This study was undertaken to determine the extent of this effect quantitatively in patients with thyroid cancer treated with I-131. Materials/Methods: Salivary gland scintigraphy was performed with Tc-99m Pertechnetate and the excretion fraction (EF) of the glands was calculated as a measure of function; measurement was performed before iodine therapy as a baseline study, and three weeks and 3 months afterwards. Clinical evaluation was also performed using a standardized subjective questionnaire. Results: Thirty-six patients (11 males and 25 females, mean age 53 years) were studied. Mean EF at 3 weeks and 3 months after radioiodine therapy was reduced compared to baseline (base 54.9%, 3 weeks 47.25%, 3 months 44.02%, p ⬍ 0.05). Loss of function was greater in parotid gland than submandibular gland (p ⬍ 0.05), confirming the higher radiosensitivity of parotid gland. There was no significant loss of function in 12 patients (33%). More salivary gland involvement was noted with increase
S557
2371
Pentoxifylline and Vitamin E Combination Improves Superficial Radiation-Induced Fibrosis
P. Haddad, B. Kalaghchi, F. Amouzegar-Hashemi Radiation Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Tehran, Iran Purpose/Objective: Radiation-induced fibrosis (RIF) remains a problematic chronic adverse effect of radiotherapy. Treatment of RIF with combined pentoxifylline (PTX) and vitamin E (vitE) has been suggested by the favorable results of recent animal and human studies. We evaluated this new treatment in a prospective “before and after” clinical trial. Materials/Methods: All patients with assessable skin and subcutaneous fibrosis in a previous radiotherapy field and no signs of tumor recurrence were eligible for this trial. After informed consent, patients received oral PTX 800 mg and vitE 1000 units per day for 3 months. The fibrotic lesion surface area and the grade of fibrosis (according to the objective grades of SOMA scale for skin and subcutaneous tissue) were recorded by 2 independent observers at 0, 1 and 3 months. A subgroup of consecutive patients from the study population received the medications for a further 3 months, with another evaluation at 6 months. Results: Thirty-seven patients entered the trial from June 2002 to April 2003, 8 of whom discontinued the medications within the first month (3 patients due to dizziness, 2 due to nausea, 1 due to swallowing difficulty from previous surgery and 2 due to reasons unrelated to treatment). Thus 29 patients presenting with 34 fibrotic lesions involving the skin and underlying tissues were treated. Patients were aged 10 –74 years with a mean age of 43 ⫾ 18 years and had a male-to-female ratio of 1.4. Previous radiation dose was 3000 – 6600 cGy with a mean of 5672 ⫾ 674 cGy and fraction size of 150 –250 cGy. Eighteen lesions were located in neck, 7 in breast, 5 in lower extremity, 2 in abdominal wall, 1 in pelvis and 1 in lower eyelid. All lesions exhibited continuous clinical regression and improvement with the therapy. The mean surface area of fibrosis for the 34 lesions was 112 ⫾ 81 cm2 at the time of study entry, 93 ⫾ 76 cm2 at 1 month (p ⬍ 0.001), and 65 ⫾ 48 cm2 at 3 months (p ⬍ 0.001). The mean grade of fibrosis was 2.32 ⫾ 0.7 at the study entry, 2.29 ⫾ 0.8 at 1 month (p ⫽ 0.3), and 2.00 ⫾ 0.8 at 3 months (p ⫽ 0.001). A subgroup of 18 patients with 21 fibrotic lesions received the medications for 6 months in total. In these lesions, the mean surface area decreased from 80 ⫾ 53 cm2 to 27 ⫾ 23 cm2 (p ⬍ 0.001) and the grade of fibrosis decreased from 2.24 ⫾ 0.8 to 1.43 ⫾ 0.7 (p ⬍ 0.001). Conclusions: PTX-vitE combination was mostly tolerated well; only 5 out of 37 patients discontinued the treatment because of side effects. It resulted in a significant reduction of fibrosis surface area and grade, more pronounced with 6 months of treatment. Our findings further confirm the efficacy of PTX-vitE combination in treatment of patients suffering from this disturbing late effect of radiotherapy.
2372
Salivary Gland Function in Patients with Differentiated Thyroid Cancer Treated with High Doses of Radioactive Iodine
A. Fard Esfahani, R. Olamie, M. Eftekhari, M. Saghari, B. Fallahi Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Tehran, Iran Purpose/Objective: Xerostomia is a well-recognized adverse effect of high-dose radioactive iodine treatment. This study was undertaken to determine the extent of this effect quantitatively in patients with thyroid cancer treated with I-131. Materials/Methods: Salivary gland scintigraphy was performed with Tc-99m Pertechnetate and the excretion fraction (EF) of the glands was calculated as a measure of function; measurement was performed before iodine therapy as a baseline study, and three weeks and 3 months afterwards. Clinical evaluation was also performed using a standardized subjective questionnaire. Results: Thirty-six patients (11 males and 25 females, mean age 53 years) were studied. Mean EF at 3 weeks and 3 months after radioiodine therapy was reduced compared to baseline (base 54.9%, 3 weeks 47.25%, 3 months 44.02%, p ⬍ 0.05). Loss of function was greater in parotid gland than submandibular gland (p ⬍ 0.05), confirming the higher radiosensitivity of parotid gland. There was no significant loss of function in 12 patients (33%). More salivary gland involvement was noted with increase
S557