International Journal of Hematology and Oncology 2023, Vol 33, Num 4 Page(s): 061-067
UTILITY OF OCTREOIDE AS SECOND LINE TREATMENT IN CONCURRENT CHEMORADIATION INDUCED DIARRHEA: PRELIMINARY RESULTS IN 20 PATIENTS

ERKAN TOPKAN1, UĞUR SELEK1

Malatya İnönü Üniv. Radyasyon Onkolojisi AD, MALATYA

Keywords: diarrhea, radiotherapy, chemotherapy, octreotid
To evaluate efficacy of octreotide in treatment of chemo-radiation induced diarrhea refractory to loperamide treatment. Our study consists of 20 intractable diarrhea patients that was resistant to loperamide, out of 33 rectum adenocarcinoma patients (T3-4NXM0) treated at Department of Radiation Oncology, Inonu University, between September 2002 and January 2003. All patients were treated with conventional radiotherapy (50.4 Gy, 1.8 Gy/fraction) with highenergy photons and concurrent 500mg/m2/week i.v. bolus 5FU. Twenty-four patients were recorded having Grade 3 or Grade 4 gastrointestinal toxicity during chemoradiation, according to National Cancer Institute Common Toxicity Criteria (NCI-CTC). Four patients who required parenteral support due to severe cramping, incontinence, gross bloody diarrhea were not included in the trial. Diarrhea failed to improve in 20 patients after 48 hours of per oral loperamide (4 mg tid) administration on outpatient basis. Twenty patients were assigned to receive octreotide (150 mg tid, Sandostatin, Novartis Pharma AG, Basel, Switzerland)) subcutaneously for 5 consecutive days. Complete resolution of diarrhea was considered therapeutic response, whereas partial or no response in 5 days of octreotide application was documented as failure. Diarrhea, recorded as NCI-CTC Grade 3 & 4, was largely experienced in the first two weekly cycles of 5FU administration concurrent with radiotherapy (80%). Subcutaneous octreotide application for 5 days resolved diarrhea completely in 17 patients out of 20 cases (85%) without any side effects (1-3 days, 15 patients-75%; 4-5 days, 2 patients- 10%). Mean response period was 2.5 days. No side effects related with octreotide application was observed. Three irresponsive patients (15%) following 5 days of octreotide treatment were recorded as failure and were hospitalized to receive additional antidiarrheal agents, antibiotics, and parenteral fluid-electrolyte support; 2 cases recovered at 7th and 1 case recovered at 8th day. Daily subcutaneous octreotide application (150 mg tid) for five days seems to be an effective, tolerable second-line treatment for concurrent chemoradiation induced diarrhea refractory to loperamide.