Medical Prevention and Treatment of Acute and Chronic Radiation Induced Enteritis - Is there any Proven Therapy? A short Review.

 

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Zusammenfassung

Hintergrund: Die Strahlenenteritis ist eine schwerwiegende Nebenwirkung bei Patienten, die im Rahmen einer Krebstherapie am Abdomen oder Becken bestrahlt werden. Trotzdem fehlen standardisierte Daten für die medikamentöse Prophylaxe und Therapie. Material und Methoden: In einer PubMed-gestützten Literatursuche wurden die aktuellen Veröffentlichungen in deutscher und englischer Sprache zum Thema „Prophylaxe und Therapie der Strahlenenteritis” gesichtet und ausgewertet. Ergebnisse: Es fanden sich vier doppelt verblindete und placebokontrollierte Studien, in denen die prophylaktische Wirkung von 5-Amionosalizylaten bei akuter Strahlenenteritis untersucht wurde. In diesen Studien konnte nur für die Gabe von Sulphasalazin (2 g/Tag) ein positiver Effekt nachgewiesen werden. Die prophylaktische Gabe von Probiotika konnte die Inzidenz der akuten Strahlenenteritis in einer doppelblinden, placebokontrollierten Studie deutlich senken. Die Wirksamkeit von Octreotid bei bereits bestehender akuter Strahlenenteritis wurde in einer randomisierten und einfach verblindeten Studie aufgezeigt. In zwei Arbeiten, eine davon randomisiert, wurde eine Wirksamkeit von Loperamid bei bestehender akuter Strahlenenteritis beschrieben. War Diarrhö auch das Hauptsymptom der chronischen Strahlenenteritis, erwies sich Loperamid in einer doppelt verblindeten, randomisierten und placebokontrollierten Studie als wirksam zur Senkung der Stuhlfrequenz. Eine retrospektive Auswertung von Patientendaten konnte Vorteile einer längerfristigen häuslichen parenteralen Ernährung gegenüber einer chirurgischen Intervention bei schwerer chronischer Strahlenenteritis mit Obstruktion oder Fistelbildung andeuten. Schlussfolgerung: Reduktion der Strahlendosis und des Bestrahlungsfeldes sind nach wie vor die wichtigsten Faktoren in der Prophylaxe der akuten und chronischen Strahlenenteritis. Weitere Untersuchungen der Pathophysiologie insbesondere der chronischen Strahlenenteritis könnten neue therapeutische Perspektiven eröffnen. So scheint beispielsweise eine Hemmung von TGF-β einen neuen Erfolg versprechenden Therapieansatz bei chronischer Strahlenenteritis darzustellen.

Abstract

Background: Radiation enteritis is a severe problem in patients receiving irradiation of the abdomen or pelvis in the course of cancer treatment. Nevertheless, there is a lack of standardised strategies for medical prevention and therapy. Materials and Methods: A PubMed based literature search was performed to address the available data on the prevention of and therapy for acute and chronic radiation enteritis. Results: Four double-blind and placebo-controlled studies used 5-aminosalycilates in the prevention of acute radiation enteritis. Only for sulphasalzine 2 g/d was a positive effect proven. Prophylactic administration of probiotics reduced the incidence of acute radiation enteritis in a large placebo-controlled trial. If acute radiation enteritis was present octreotide ameliorated radiation-induced diarrhoea in a randomised study. Two investigations, only one of them randomised, described the effectiveness of loperamide in the treatment of acute radiation enteritis. If diarrhoea was also the main symptom of chronic radiation enteritis, loperamide reduced stool frequency in a double-blind and placebo-controlled study. A retrospective analysis of severe cases of chronic radiation enteritis with obstruction and fistula indicated that parenteral nutrition at home was more effective than surgery. Conclusion: Reduction of radiation dose and field size are still the most important factors in the prevention of acute and chronic radiation enteritis. Valid data particularly on the treatment of chronic radiation enteritis are lacking. A better understanding of the pathopysiology especially in chronic radiation enteritis might offer new therapeutic perspectives. Inhibition of TGF-β, for example, might be a new promising therapy approach.

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Manfred V. Singer, M. D.

Department of Medicine II, Medical Faculty at Mannheim, University of Heidelberg

Theodor Kutzer Ufer 1 - 3

68167 Mannheim

Germany

Phone: ++ 49/6 21/3 83 32 84

Fax: ++ 49/6 21/3 83 38 05

Email: manfred.v.singer@med.ma.uni-heidelberg.de