Immunohistochemistry The apoptotic index (AI) was calculated in bowel specimens from both groups (A and R) and was analysed in relation to the timing of radiotherapy (AI1 = biopsy before the initiation of radiotherapy, AI2 = biopsy after the completion of radiotherapy and AP3

= biopsy at least six months after the end of radiotherapy). In the A group of patients the AI1, AI2 and AI3 were [mean ± SD] 1.0 ± 0.6, 1.1 ± 0.7 and 1.4 ± 0.8 and in the R group of patients the AI1, AI2, AI3 were 1.0 ± 0.6, 1.3 ± 1.0 and 0.9 ± 0.3 respectively [Figure 3]. No significant differences were observed for the AI1, AI2 and AI3 between the two patient groups. Concordance of endoscopic and histopathological findings The concordance between histologically defined radiation colitis and endoscopic findings was rather poor with endoscopy findings underestimating bowel mucosal click here injury. Characteristically, in patients with endoscopically mild to moderate colitis (EORTC/RTOG grade 1-2) the corresponding large bowel mucosa histologic changes were disproportionally pronounced. Radiation colitis management All cases of RC were manageable. In cases of mild to moderate RC (grade

I and II), patients were treated on outpatient basis. For more severe symptoms (grade III and IV) hospitalisation this website was necessary for 10-15 days. Mild and moderate RC cases were treated with corticosteroid and mesalamine enemas administered twice daily for a period of 10-20 days according to clinical response. Discussion This is the first randomized explanatory study that assessed amifostine efficacy in patients undergoing external beam irradiation for pelvic malignancies by means of combining clinical, endoscopic and histological data. Patients on prophylactic subcutaneous amifostine developed less acute RC compared to patients who did not receive amifostine prophylaxis, yet the small size of this study did not allow us to reach to statistically significant findings. However, acute RC and grade IV radiation colitis did not occur in the amifostine arm but only

in four patients (17.4%) who did not receive amifostine prophylaxis (arm R). In parallel with our data a study with one hundred patients with inoperable, unresectable, or recurrent adenocarcinoma of the rectum were Protein kinase N1 stratified and randomized to amifostine plus radiation therapy (A) or radiation therapy (R) only treatment arms. According to this study, the administration of amifostine concomitant to radiation for advanced rectal cancer, was Selleck HSP inhibitor reported to significantly reduce acute and late pelvic radiation toxicity [15, 16]. Furthermore, several studies have also shown a radiation protective function of amifostine to perineal, skin, bladder, and bowel mucosa in patients irradiated for pelvic area malignancies [17–31]. Overall, there is accumulating data demonstrating that amifostine may protect from acute and late onset colitis and well-designed short and long-term protection protocols may prove of great importance.