• Anurag K Singh, Cynthia Ménard, Peter Guion, Nicole L Simone, Sharon Smith, Nancy Sears Crouse, Denise J Godette, Theresa Cooley-Zgela, Linda C Sciuto, Jonathan Coleman, Peter Pinto, Paul S Albert, Kevin Camphausen, and C Norman Coleman.
• Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.
• Int. J. Radiat. Oncol. Biol. Phys. 2006 Jul 15; 65 (4): 1008-13.

PurposeOur goal was to test the ability of intrarectal amifostine to limit symptoms of radiation proctitis.Methods And MaterialsThe first 18 patients received 1 g of intrarectal amifostine suspension placed 30-45 min before each radiation treatment. The following 12 patients received 2 g of amifostine. Total dose prescribed ranged from 66 to 76 Gy. All patients were treated with three-dimensional conformal radiation therapy. The suspension remained intrarectal during treatment and was expelled after treatment. For gastrointestinal symptoms, during treatment and follow-up, all patients had a Radiation Therapy Oncology Group (RTOG) grade recorded.ResultsMedian follow-up was 18 months (range, 6-24 months). With 2 g vs. 1 g amifostine, there was a nearly significant decrease in RTOG Grade 2 acute rectal toxicity. Seven weeks after the start of radiation therapy, the incidence of Grade 2 toxicity was 33% in the 1-g group (6/18) compared with 0% (0/12) in the 2-g group (p=0.06). No Grade 3 toxicity or greater occurred in this study.ConclusionThis trial suggests greater rectal radioprotection from acute effects with 2 g vs. 1 g amifostine suspension. Further studies should be conducted in populations at higher risk for developing symptomatic acute and late proctitis.

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