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 PMID 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 PMID 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 - PMID 15108223 Full text &mdash; "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.