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 1(st), 11(th) and 21(st) 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 2 toxicity 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 6 patients 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.

Endobronchial metastases from a leiomyosarcoma of the uterus.

A 63-year-old woman presented with dyspnea, non-productive cough and chest pain. On computed tomography of the thorax, near total atelectasis of the left lung was reported. On bronchoscopic examination, a mass lesion was observed in the mucosa of the left main bronchus leading to near total obstruction. Her medical history revealed that she had been treated with total abdominal hysterectomy and adjuvant radiation therapy for a leiomyosarcoma of the uterus one year ago. She was diagnosed as having a metastatic leiomyosarcoma and was treated with palliative radiation therapy. Six months later, she presented with disseminated disease involving the thorax and the pelvis. She refused further treatment and died one month later. Patients with leiomyosarcomas of the uterus might follow an aggressive clinical course, with relatively early metastases at unusual sites.