ZUHL, GermanyAmifostine (Ethyol) used as cytoprotective therapy
can reduce the occurrence of xerostomia, loss of taste, and fibrosis associated
with radiochemotherapy for head and neck cancer. Jens Buentzel, MD, PhD,
reported results of three studies at The First Investigators’ Congress on
Radio-protection, held at the Kimmel Cancer Center at Jefferson University,
Philadelphia. Dr. Buentzel is vice chairman of the Department of
Otolaryngology, Head and Neck Oncology, Zentralklinikum Zuhl, Germany.
The pilot trial was a controlled phase II study involving 14 patients
randomized to receive standard radiochemotherapy, with radiation administered
in 2-Gy fractions to a total dose of 60 Gy, plus carboplatin (Paraplatin) 70
mg/m² as a radiosensitizer on weeks 1 and 5.
Another 14 patients received the same regimen plus amifostine 500 mg given
prior to carboplatin as a short infusion over approximately 10 minutes. The
time interval between amifostine administration and the end of daily
irradiation was less than 60 minutes, and no cytoprotectant was given on days
of radiotherapy alone.
Amifostine significantly reduced mucositis, xerostomia, dysphagia, ageusia,
and dermatitis rates, as well as anemia, leukocytopenia, and thrombocytopenia.
Dr. Buentzel concluded that amifostine could reduce the typical acute
chemotherapy-related toxicities and should be able to reduce radiation-induced
acute toxicities but must be administered within an interval of no more than 60
minutes prior to the end of radiotherapy.
"At 5 years after treatment, the survival rate in the amifostine group
is a little bit better than in the control group, and we have no sign of tumor
protection," Dr. Buentzel said. "There was a surprising decrease in
nonhematologic toxicities. These were the first data to show a reduction of
mucositis from amifostine given prior to chemotherapy. We see similar results
in clinical practice. I would like to focus attention on the reduction of
severity of mucositis, dysphagia, and loss of taste. These effects should be
examined in larger studies."