Effects of Pentoxifylline and Tocopherol in Combating Toxicities Associated with Preoperative Concurrent Chemoradiation of Locally Advanced Rectal Cancer

Abstract

Background: Concurrent chemoradiation is an essential part in the treatment of locally advanced rectal cancer and causes significant toxicities. Severe toxicity may cause treatment interruption and decrease local control rate. Management of treatment related complications are being studied worldwide.  Objectives: To determine the efficacy of Pentoxifylline and Tocopherol in combating toxicities in locally advanced rectal cancer during concurrent chemo-radiation.  Methods: A quasi-experimental study was conducted from November 2020 to October 2021, involving 80 patients (40 in each arm). Arm A received Pentoxifylline (400 mg) and Tocopherol (400 mg) twice daily alongside CCRT, while Arm B received only CCRT. Toxicity data were collected from the start of CCRT until 12 weeks post-treatment. Data were analyzed using independent sample t-tests for continuous variables and Chi-square tests for categorical variables. Results: Arm A demonstrated fewer cases of diarrhea, rectal bleeding, pelvic pain, and per rectal discharge at 4th and 6th weeks during CCRT and 6 and 12 weeks after treatment compared to Arm B. Hospitalization rates were significantly lower in Arm A (17.5%) compared to Arm B (37.5%) (p < 0.05). The mean length of hospital stay was shorter in Arm A (5.3 ± 1.7 days) compared to Arm B (10 ± 1.9 days) (p < 0.05). Treatment interruptions occurred in 20% of Arm A patients and 42.5% of Arm B patients (p < 0.05). No significant difference in treatment response was noted between the groups (67.5% in Arm A vs 62.5% in Arm B, p > 0.05). Conclusion: Prophylactic use of Pentoxifylline and Tocopherol at the beginning of CCRT in locally advanced rectal cancer may be beneficial in terms of minimizing toxicities, preventing treatment break and reducing hospital admission.