Role of triamcinolone in radiation enteritis management

AIM:To investigate the role of triamcinolone in the management of acute and chronic enteritis caused by pelvic radiotherapy.METHODS:Twenty-eight patients with rectum adenocarcinoma or endometrium adenocarcinoma were studied.We compared the results of 14 patients treated with injected triamcinolone acetonide(TA)with those of 14 patients who were not treated with TA.For the TA group,40 mg of TA was injected intramuscularly on the 1st,11th and 21st d of radiotherapy;the control group received no injections.All of the study participants had a median age of 65 years,had undergone postoperative radiotherapy and were evaluated weekly using Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer Acute Morbidity Score Criteria,and complete blood counts for every 10 d.RESULTS:Triamcinolone was found to effectively prevent and treat radiation-induced acute gastrointestinal(enteritis)and genitourinary(cystitis)side effects(P=0.022 and P=0.023).For the lower GI side effect follow up,11 patients in the control group had Grade 2toxicity and 3 patients had Grade 1 toxicity.In the TA group,5 patients had Grade 2 toxicity and 9 patients had Grade 1 toxicity.For the genitourinary system side effect follow up,4 patients had Grade 2 toxicity and 6patients had Grade 1 toxicity.Additionally,2 patients had Grade 2 toxicity and 2 patients had Grade 1 toxicity.The neutrophil counts did not differ between the TA group and the control group.There was no meaningful difference between age groups and primary cancers.At the 12th mo of follow up,there were no differences between groups for chronic side effects.CONCLUSION:Triamcinolone is a moderately potent steroid,that is inexpensive and has a good safety profile.It would be beneficial for reducing medical expenses related to treatment of radiation induced enteritis.

Impact of adjuvant treatment modalities on survival outcomes in curatively resected pancreatic and periampullary adenocarcinoma

Background： We examined the impact of adjuvant modalities on resected pancreatic and periampullary adenocarcinoma（PAC）.Methods： A total of 563 patients who were curatively resected for PAC were retrospectively analyzed between 2003 and 2013.Results： Of 563 patients, 472 received adjuvant chemotherapy（CT） alone, chemoradiotherapy（CRT） alone, and chemoradiotherapy plus chemotherapy（CRT-CT） were analyzed. Of the 472 patients, 231 were given CRT-CT, 26 were given CRT, and 215 were given CT. The median recurrence-free survival（RFS） and overall survival（OS） were 12 and 19 months, respectively. When CT and CRT-CT groups were compared, there was no significant difference with respect to both RFS and OS, and also there was no difference in RFS and OS among CRT-CT, CT and CRT groups. To further investigate the impact of radiation on subgroups, patients were stratified according to lymph node status and resection margins. In node-positive patients, both RFS and OS were significantly longer in CRT-CT than CT. In contrast, there was no significant differencebetween groups when patients with node-negative disease or patients with or without positive surgical margins were considered.Conclusions： Addition of radiation to CT has a survival benefit in patients with node-positive disease following pancreatic resection.