Radiation Oncology/Supportive care/Diarrhea

Diarrhea low fiber diet Sandostatin Paregoric Prophylaxis: 5-ASA drugs (oral): Mesalamine (Asacol, Pentasa) - is 5-ASA without side chains Sulfasalazine (Azulfidine) - 500 mg BID Balsalazide (Colazal) - 3 x 750 mg tabs BID (i.e. 2250 mg twice a day) Prodrug cleaved in the colon to mesalamine. Olsalazine - 2 5-ASA molecules bound 5-ASA enemas, foams Selenium Lippe Hospital, Germany (2000-2006) -- selenium vs control Randomized. 81 patients with uterine (88%) or cervical (12%) cancer. If pretreatment selenium <84 ug/l randomized to Arm 1) selenium 500 ug PO daily vs Arm 2) control. Primary endpoint: efficiency of supplementation 2010 20133068 -- "Multicenter, Phase 3 Trial Comparing Selenium Supplementation With Observation in Gynecologic Radiation Oncology." (Muecke R, Int J Radiat Oncol Biol Phys. 2010 Feb 2. [Epub ahead of print]) Outcome: Selenium level post RT significantly higher with supplement. Grade 2+ diarrhea selenium 20% vs no selenium 44% (SS). No difference in other measures Conclusion: Selenium supplementation effective in improving blood selenium status in deficient patients, and reduces RT-induced diarrhea Octreotide RTOG 0315 (2003-2006) -- octreotide vs placebo Randomized. 215 patients, rectal or anal cancer. Arm 1) long-acting octreotide 30 mg given 4-7 days before RT, and again day 22 vs Arm 2) placebo. Primary endpoint Grade 2+ diarrhea 2010 20339140 -- "Octreotide acetate in prevention of chemoradiation-induced diarrhea in anorectal cancer: randomized RTOG trial 0315." (Zachariah B, J Natl Cancer Inst. 2010 Apr 21;102(8):547-56. Epub 2010 Mar 25.) Median F/U 10 months Outcome: Grade 2-4 acute diarrhea octreotide 44% vs placebo 49% (NS). No difference in chemotherapy delivery, RT delivery, medical resource utilization, bowel function or QoL Conclusion: Prophylactic use of octreotide had no benefit Guidelines: For gastrointestinal mucositis - 15108223 Full text — "Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis." Rubenstein EB et al. Cancer. 2004 May 1;100(9 Suppl):2026-46.