Plasma citrulline concentration: A surrogate end point for radiation-induced mucosal atrophy of the small bowel. A feasibility study in 23 patients

Lutgens, LCHW;Deutz, N;Granzier-Peeters, M;Beets-Tan, R;Lambin, Philippe;et.al.
(2004) International Journal of Radiation: Oncology - Biology - Physics — Vol. 60, n° 1, p. 275-285 (2004)

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Authors
  • Lutgens, LCHW
    Author
  • Deutz, N
    Author
  • Granzier-Peeters, M
    Author
  • Beets-Tan, R
    Author
  • Gueulette, JohnUCLouvain
    Author
  • Lambin, PhilippeUnamur
    Author
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Abstract
Purpose: Plasma citrulline, a nitrogen end product of glutamine metabolism in small-bowel enterocytes, was suggested as a marker of radiation-induced small-bowel epithelial cell loss in mice after single-dose whole-body irradiation. Our objective was to evaluate the feasibility of citrulline as a marker for radiation-induced small-intestinal mucosal atrophy in patients during and after abdominal fractionated radiotherapy. Methods and Materials: Twenty-three patients were studied weekly during treatment and at intervals of 2 weeks and 3 and 6 months after treatment by postabsorptive plasma citrulline concentration and clinical toxicity grading. The interrelationship between these variables and the correlation with small-bowel dose and volume parameters were investigated. Results: During fractionated radiotherapy, citrulline concentration significantly decreased as a function of the radiation dose (p < 0.001) and the volume of small bowel treated (p = 0.001). The plasma citrulline concentration correlated with clinical toxicity during the last 3 weeks of treatment. As a whole, citrulline concentration correlated better with radiation dose and volume parameters than clinical toxicity grading. Conclusions: In patients treated with fractionated radiation therapy for abdominal or pelvic cancer sites, plasma citrulline concentration may be a simple objective marker for monitoring epithelial cell loss, a major event in acute radiation-induced small-bowel toxicity. (C) 2004 Elsevier Inc.
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Lutgens, L., Deutz, N., Granzier-Peeters, M., Beets-Tan, R., De Ruysscher, D., Gueulette, J., Cleutjens, J., Berger, M., Wouters, B., von Meyenfeldt, M., & Lambin, P. (2004). Plasma citrulline concentration: A surrogate end point for radiation-induced mucosal atrophy of the small bowel. A feasibility study in 23 patients. International Journal of Radiation: Oncology - Biology - Physics, 60(1), 275-285. https://doi.org/10.1016/j.ijrobp.2004.02.052 (Original work published 2004)