Plasma Citrulline: A Marker for Monitoring & Quantifying Radiation-Induced Small Bowel Toxicity

Diarrhea Clinical Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01849107
• Other study ID #: CTR_SB_2013
• Status: Completed
• Phase: N/A
• Start date: April 2013
• Est. completion date: December 2014

Study information

• Verified date: January 2020
• Source: Asan Medical Center
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Small bowel irradiation results in epithelial cell loss and consequently impairs function and metabolism. A metabolic end product of small bowel enterocytes is plasma citrulline. The investigators evaluate the correlation between plasma citrulline level, dose-volume histogram of small bowel, and small bowel toxicity grade by Common Terminology Criteria for Adverse Events version 4.0 (CTCAE ver.4.0) to investigate whether citrulline can be used as a biomarker for quantifying radiation-induced epithelial cell loss.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 49
• Est. completion date: December 2014
• Est. primary completion date: December 2013
• Accepts healthy volunteers: No
• Gender: All
• Age group: 20 Years and older

Eligibility

Inclusion Criteria:

• Histologically confirmed cancer patients

• Appropriate liver, renal, and bone marrow function for radiotherapy

• Willing to provide informed written consent

• At least 20 years old

Exclusion Criteria:

• prior abdominopelvic radiation therapy or chemotherapy or abdominal surgery

• Any contraindication to radiotherapy (i.e. Severe connective tissue disorder, etc.)

• Prior or simultaneous history of other malignancy

• On medication for small bowel disease or CTCAE 4.0 Grade 1 or higher toxicity before radiation

• Any treatment delay more than 1 week during radiotherapy

• No radiotherapy due to any other reason except small bowel toxicity

Related Conditions & MeSH terms

• Anorexia
• Diarrhea
• Dyspepsia

Intervention

Biological:
• Plasma citrulline

Locations

Country	Name	City	State
Korea, Republic of	Asan Medical Center	Seoul

Sponsors (1)

Lead Sponsor	Collaborator
Asan Medical Center

Country where clinical trial is conducted

Korea, Republic of, 

References & Publications (18)

Atahan IL, Onal C, Ozyar E, Yiliz F, Selek U, Kose F. Long-term outcome and prognostic factors in patients with cervical carcinoma: a retrospective study. Int J Gynecol Cancer. 2007 Jul-Aug;17(4):833-42. Epub 2007 Mar 15. — View Citation

Choi HJ, Kim YS, Lee SH, Lee YS, Park G, Jung JH, Cho BC, Park SH, Ahn H, Kim CS, Yi SY, Ahn SD. Inter- and intra-observer variability in contouring of the prostate gland on planning computed tomography and cone beam computed tomography. Acta Oncol. 2011 May;50(4):539-46. doi: 10.3109/0284186X.2011.562916. Epub 2011 Mar 10. — View Citation

Crenn P, Messing B, Cynober L. Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction. Clin Nutr. 2008 Jun;27(3):328-39. doi: 10.1016/j.clnu.2008.02.005. Epub 2008 Apr 28. Review. — View Citation

Crenn P, Vahedi K, Lavergne-Slove A, Cynober L, Matuchansky C, Messing B. Plasma citrulline: A marker of enterocyte mass in villous atrophy-associated small bowel disease. Gastroenterology. 2003 May;124(5):1210-9. — View Citation

Herbers AH, Feuth T, Donnelly JP, Blijlevens NM. Citrulline-based assessment score: first choice for measuring and monitoring intestinal failure after high-dose chemotherapy. Ann Oncol. 2010 Aug;21(8):1706-11. doi: 10.1093/annonc/mdp596. Epub 2010 Jan 20. — View Citation

Kim JY, Kim JY, Kim JH, Yoon MS, Kim J, Kim YS. Curative chemoradiotherapy in patients with stage IVB cervical cancer presenting with paraortic and left supraclavicular lymph node metastases. Int J Radiat Oncol Biol Phys. 2012 Nov 1;84(3):741-7. doi: 10.1016/j.ijrobp.2012.01.070. Epub 2012 Aug 14. — View Citation

Kim YS, Kim JH, Ahn SD, Lee SW, Shin SS, Nam JH, Kim YT, Kim YM, Kim JH, Choi EK. High-dose extended-field irradiation and high-dose-rate brachytherapy with concurrent chemotherapy for cervical cancer with positive para-aortic lymph nodes. Int J Radiat Oncol Biol Phys. 2009 Aug 1;74(5):1522-8. doi: 10.1016/j.ijrobp.2008.10.024. Epub 2009 Feb 21. — View Citation

Kim YS, Kim JH, Yoon SM, Choi EK, Ahn SD, Lee SW, Kim JC, Yu CS, Kim HC, Kim TW, Chang HM. lymph node ratio as a prognostic factor in patients with stage III rectal cancer treated with total mesorectal excision followed by chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2009 Jul 1;74(3):796-802. doi: 10.1016/j.ijrobp.2008.08.065. Epub 2009 Mar 14. — View Citation

Kim YS, Park SH, Ahn SD, Lee JE, Choi EK, Lee SW, Shin SS, Yoon SM, Kim JH. Differences in abdominal organ movement between supine and prone positions measured using four-dimensional computed tomography. Radiother Oncol. 2007 Dec;85(3):424-8. Epub 2007 Nov 26. — View Citation

Kim YS, Shin SS, Nam JH, Kim YT, Kim YM, Kim JH, Choi EK. Prospective randomized comparison of monthly fluorouracil and cisplatin versus weekly cisplatin concurrent with pelvic radiotherapy and high-dose rate brachytherapy for locally advanced cervical cancer. Gynecol Oncol. 2008 Jan;108(1):195-200. Epub 2007 Oct 25. — View Citation

Lee YS, Kim YS, Kim JH, Ahn SD, Lee SW, Shin SS, Nam JH, Kim YT, Kim YM, Kim JH, Choi EK. Feasibility and outcome of concurrent chemoradiotherapy for recurrent cervical carcinoma after initial surgery. Tumori. 2010 Jul-Aug;96(4):553-9. — View Citation

Letschert JG, Lebesque JV, Aleman BM, Bosset JF, Horiot JC, Bartelink H, Cionini L, Hamers JP, Leer JW, van Glabbeke M. The volume effect in radiation-related late small bowel complications: results of a clinical study of the EORTC Radiotherapy Cooperative Group in patients treated for rectal carcinoma. Radiother Oncol. 1994 Aug;32(2):116-23. Review. — View Citation

Lutgens LC, Blijlevens NM, Deutz NE, Donnelly JP, Lambin P, de Pauw BE. Monitoring myeloablative therapy-induced small bowel toxicity by serum citrulline concentration: a comparison with sugar permeability tests. Cancer. 2005 Jan 1;103(1):191-9. — View Citation

Lutgens LC, Deutz N, Granzier-Peeters M, Beets-Tan R, De Ruysscher D, Gueulette J, Cleutjens J, Berger M, Wouters B, von Meyenfeldt M, Lambin P. Plasma citrulline concentration: a surrogate end point for radiation-induced mucosal atrophy of the small bowel. A feasibility study in 23 patients. Int J Radiat Oncol Biol Phys. 2004 Sep 1;60(1):275-85. — View Citation

Lutgens LC, Deutz NE, Gueulette J, Cleutjens JP, Berger MP, Wouters BG, von Meyenfeldt MF, Lambin P. Citrulline: a physiologic marker enabling quantitation and monitoring of epithelial radiation-induced small bowel damage. Int J Radiat Oncol Biol Phys. 2003 Nov 15;57(4):1067-74. — View Citation

Onal C, Kotek A, Unal B, Arslan G, Yavuz A, Topkan E, Yavuz M. Plasma citrulline levels predict intestinal toxicity in patients treated with pelvic radiotherapy. Acta Oncol. 2011 Nov;50(8):1167-74. doi: 10.3109/0284186X.2011.584557. Epub 2011 Aug 24. — View Citation

Packey CD, Ciorba MA. Microbial influences on the small intestinal response to radiation injury. Curr Opin Gastroenterol. 2010 Mar;26(2):88-94. doi: 10.1097/MOG.0b013e3283361927. Review. — View Citation

Park JH, Kim YS, Ahn SD, Choi EK, Shin SS, Kim YT, Kim YM, Kim JH, Yi SY, Nam JH. Concurrent chemoradiotherapy or radiotherapy alone for locally advanced cervical cancer in elderly women. Tumori. 2010 Nov-Dec;96(6):959-65. — View Citation

* Note: There are 18 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Correlation coefficient between plasma citrulline and toxicity grade by CTCAE 4.0		1 year
Primary	Serial changes in plasma citrulline level baseline, on 3rd week during, on the day of completion of radiotherapy, and 3 months post-radiotherapy.		1 year
Secondary	Correlation coefficient between plasma citrulline and dose-volume histogram of small bowel.		1 year