Sucralfate, an
aluminum hydroxide complex of sulfated
sucrose used in the treatment of
gastric ulcer, was shown to prevent irradiation-induced
diarrhea and bowel discomfort significantly in patients treated for
pelvic cancer with external
radiotherapy with intent to cure. The double-blind placebo-controlled study included 70 patients with
carcinoma of the prostate and urinary bladder without distant
metastasis (T1-4NO1xMO) and performance status of greater than or equal to 90% Karnofsky scale.
Radiotherapy was administered in a conventional manner with MeV photons and a four-field technique. The total dose was 62-66 Gy and total treatment time of 6.5 weeks. Dose granules of
sucralfate or placebo were dispensed to each patient 2 weeks after radiation started and continued for 6 weeks. All analyses were performed blindly. Seven of 34 evaluable patients in the placebo group and 18 of 32 evaluable patients in the
sucralfate group did not present with
diarrhea during the observation period. The frequency of defecation and stool consistency were significantly improved by
sucralfate. Fourteen patients in the placebo group and only three in the
sucralfate group required symptomatic
therapy with
loperamide. There was no evidence of adverse effects associated with the use of
sucralfate.
Sucralfate can be of beneficial value in diminishing the bowel discomfort during
radiotherapy of pelvic
malignancies, and the earlier proposed mechanisms of action (e.g., protection of denuded mucosa, cytoprotective properties, binding
bile acids) can also be valid for the current effects of
sucralfate.