A prospective study of faecal calprotectin and lactoferrin in the monitoring of acute radiation proctitis in prostate cancer treatment

Objective. Acute radiation proctitis is a relevant complication of pelvic radiation. The purpose of this study was to investigate two markers of gut inflammation as non-invasive diagnostic tools to evaluate acute radiation proctitis. Material and methods. Twenty patients who underwent radiotherapy for prostate cancer took part in this prospective study. Radiation-induced toxicity was evaluated weekly during radiotherapy in compliance with the CTC toxicity criteria. Stool samples from patients were examined before treatment, weekly during radiotherapy and 2 weeks after the end of radiotherapy using enzyme-linked immunosorbent assay for calprotectin and lactoferrin and correlated with the CTC toxicity. Results. Calprotectin and lactoferrin faecal values increased significantly during radiation treatment and decreased about 2 weeks after cessation of radiation. Faecal concentrations of calprotectin and lactoferrin correlated with the documented radiation proctitis symptoms (all grades together) in 15/20 patients (75%). With respect to changes in faecal concentrations and correspondence to proctitis symptoms, both markers showed parallel results in 90% of the patients. On comparing calprotectin and lactoferrin concentrations between the 4th week of radiation and the 1st week, it was found that patients with any grade of toxicity exhibited a significantly higher increase in calprotectin (p=0.044) and lactoferrin (p=0.05), respectively, compared with those without toxicity. Conclusions. Calprotectin and lactoferrin faecal values changed during radiation treatment and after cessation of radiation, with correlation to acute proctitis symptoms in most of the patients. Before markers are used to monitor acute radiation proctitis, further experience should be acquired. Patients will be followed to determine the predictive value of the two tested markers for chronic radiation proctitis.