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Can we decrease the acute proctitis in prostate cancer patients using hyaluronic acid during radiation therapy: a prospective historically controlled clinical study.

An acute proctitis of different extension and seriousness may develop during radiation therapy for prostate cancer. It represents a local untoward side effect that can delay or halt the radiotherapy, besides causing a distress to the patient. The possible consequence is the reduction of the expected anti-tumour therapy effect. To reduce such a proctitis, frequently accompanied by diarrhea, various pharmacological agents may be used, as 5-aminosalicylic acid and its precursors, corticosteroid and so on. However the efficacy of such therapy is not satisfactory in all cases, or possibility the symptoms may be worsened. On the other hand, the Na-hyaluronic acid (Na-HA) is safely used also as eye-drop, intra-articularly injected, accord-ing to the safety of the drug. Also, it helps against the skin toxicity by Radiotherapy, as cream, gel or spray. Good results have been obtained in preventing or reducing the cystitis radiation 1 . The recent report by the Fiorica’s et al have shown that the use of HA-suppository before the daily radiation fraction reduces the acute rectal toxicity (end point of the study). The results represents only a statistical trend ( p < 0.04). However, with no negative side effects of such a medication. The comparison of various possible side effects have been performed versus historical controls who did not received the HA nor other rectal medication. We may presume that in the historical reference group of 100 patients, well matched with the H-A treated patients (as from the Table II of the paper) 2 , the radiotherapy rectal toxicity could be under looked owing to “previous” clinical observation. The androgen deprivation therapy (ADT), neo-adjuvant, con-comitant or adjuvant to radiation therapy, in many series, seems not increase the rectal toxicity