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Vitamin A Reduces Nonbleeding Symptoms of Chronic Radiation Proctopathy

Symptom severity in prostate cancer patients was reduced by twice-daily administration of vitamin A.

Rectal bleeding associated with chronic radiation proctopathy can be managed easily by destroying telangiectasis with endoscopic therapy. However, other symptoms of radiation proctopathy, such as diarrhea, urgency, rectal pain, tenesmus, and fecal incontinence, typically are treated with symptom-based therapies, such as antidiarrheals and antispasmodics. Vitamin A accelerates wound healing in laboratory animals, and the authors of the current paper previously described a case of dramatic healing of radiation-induced anal ulceration in an HIV-infected patient with anal carcinoma. Now, they report the results of a randomized controlled trial in which 17 patients who had symptoms of chronic radiation proctopathy received oral retinol palmitate (vitamin A, 10,000 IU twice daily) or placebo.

Most patients had received radiation for prostate cancer. Patients were excluded if they had liver disease, rectal ulcerations, strictures, fistulization, or hemoglobin levels <10 mg/dL or had received two or more units of packed red blood cells for anemia. Response to treatment was defined as a reduction of at least two symptoms by at least two points on a Likert scale (1-6) for severity and frequency. Two placebo recipients versus seven vitamin A recipients responded to treatment (P=0.057). All five placebo nonresponders who crossed over to open-label vitamin A therapy for 90 days responded. The mean change in the radiation proctopathy score was significantly higher in the vitamin A group than in the placebo group (11.0 vs. 2.5).

Comment: If substantiated by additional studies, this discovery would dramatically advance the treatment of a difficult clinical problem. Whether patients with more advanced disease, including rectal ulceration, would respond is uncertain. Although bleeding symptoms are controlled easily by endoscopic measures, it would be of interest to know whether vitamin A improves healing of endoscopically induced ulcerations caused by the treatment of telangiectasia. The authors note that they currently treat patients with 10,000 IU of vitamin A twice daily for 12 weeks and then reduce the dosage to 10,000 IU daily. They have not observed changes in liver enzymes with these dosages.

— Douglas K. Rex, MD

Published in Journal Watch Gastroenterology April 12, 2005

Citation(s):

Ehrenpreis ED et al. A prospective, randomized, double-blind, placebo-controlled trial of retinol palmitate (vitamin A) for symptomatic chronic radiation proctopathy. Dis Colon Rectum 2005 Jan; 48:1-8.

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