Prevention of pelvic radiation disease

Table 1 Efficacy of drugs as possible preventive agents of pelvic radiation disease

Drug	Route ofadministration	Type ofevidence	Prevention		Comments
			Acute PRD	Chronic PRD
Amifostine	IV or SC	RCTs	Yes	No	A dose of 340 mg/m2 IV or 500 SC administered during the whole period of treatment may prevent acute but not late-onset symptoms Nausea and vomiting are common side effects
Amifostine	Rectal	RCTs	Yes	?	Intrarectal administration is feasible and seems safe A dose of 1–2 g/d administered during the whole period of treatment may prevent acute symptoms A dose of 2 g/d seems more effective than 1 g/d No systemic side effects reported No definitive data on long-term effect Large multicenter RCTs are warranted
Sulfasalazine	Oral	RCT	Yes	?	A dose of 1000 mg/d significantly reduces the risk of developing diarrhea during radiation treatment
Balsalazide	Oral	RCT	Yes	No	Daily dose of 6 capsules may reduce compliance to the preventive treatment in clinical practice Possible beneficial effect Large multicenter RCTs are warranted
Mesalazine	Oral or rectal	RCTs	No	?	No beneficial or even harmful effects on acute symptoms
Beclomethasone	Rectal	RCT	No	Yes	Possible preventive effect on late-onset rectal bleeding and cost-effective preventive strategy
Sucralfate	Oral	RCTs	No	No	No beneficial or even harmful effect as preventive agents on both acute and late-onset symptoms Useful for treating rectal bleeding
Probiotics	Oral	RCTs	Yes	?	Large multicenter RCTs are warranted
		Meta-analysis

IV: Intravenous; SC: Subcutaneous; RCT: Randomized controlled trial; PRD: Pelvic radiation disease.