Efficacy of Sucralfate Ointment in Prevention of Acute Proctitis in Cancer Patients: a Randomized Controlled Clinical Trial

Acute radiation proctitis (ARP) is a usual adverse effect in patients undergoing pelvic radiotherapy. The symptoms include diarrhea, rectal blood or mucus discharge, fecal urgency and tenesmus with pain. Sucralfate, an aluminum-based salt of sucrose octasulfate, is a cytoprotective agent that forms a coating barrier at injured sites by adhering to mucoproteins. It has been used in topical management of a wide variety of local lesion. This study was designed to evaluate the preventive effect of rectal sucralfate on acute radiotherapy induced proctitis.

Seven percent sucralfate ointment was prepared for topical use. Drug quantification, chemical stability and microbial limit tests were performed carefully. In this randomized double blind placebo controlled trial, fifty-seven patients with pelvic malignancies undergoing radiotherapy were allocated to receive either 1 g of sucralfate or 1 g of placebo, given as a twice daily ointment, one day before and during radiotherapy for six weeks. The eligible patients were evaluated based on RTOG acute toxicity criteria and the following ARP symptoms weekly: rectal hemorrhage, diarrhea, rectal pain, and fecal urgency.  The influence of symptoms on lifestyle were also recorded weekly.

Acute proctitis was significantly less prevalent in patients in the sucralfate group. The incidence of rectal bleeding (P=0.003), diarrhea (P= 0.002), rectal pain (P=<0.001) and fecal urgency (P=0.002) were significantly less common in the sucralfate group. No statistically significant difference was observed for radiotherapy induced cystitis in the placebo and sucralfate groups (P=0.27).

This study suggests that sucralfate7% ointment reduces the incidence of symptoms associated with acute radiation proctitis.