Effects of Radiation Therapy on the Urinary Excretion of Niacin and Riboflavin in Patients with Malignant Diseases

Abstract

Concepts concerning the etiology of radiation sickness have been numerous and varied. In 1906, Edsall and Pemberton suggested that the vomiting was toxic in nature and was due to unknown decomposition products of tissue destruction (5). Later, Hall and Whipple (7) attributed the effects to injury of the epithelial cells, and Rolleston (14) felt that proteins liberated by the destruction of cells were responsible for the symptoms. Holmes and Hunter noted that the manifestations closely resembled those seen in patients with catarrhal jaundice, and suggested the possibility of a disturbance of liver function as the underlying cause (8). More recently, there has been much interest in the relationship of vitamins to radiation sickness. Martin and Moursund, in 1938, pointed out that this condition resembled a vitamin B₁ deficiency and stated that vitamin B₁ protected guinea-pigs from sickness following small doses of radiation over the abdomen (10). In the same year, Spies and his co-workers found that patients with radiation sickness, like pellagrins, have porphyrinuria (1). They stated that the administration of niacin relieved the symptoms and caused the urinary porphyrin to return to normal. They suggested that the basic disorder in x-ray sickness was a disturbance of the respiratory enzyme systems and recommended the empiric use of vitamins, especially niacin and thiamine. In the past ten years, various purified vitamin substances have been used singly and in combination for the treatment and prevention of radiation sickness. The vitamins most frequently stated to be effective are thiamine, niacin, and pyridoxine. The good results initially reported have often proved to be short-lived, and treatment with vitamins has been shown to be of doubtful value. It seems generally agreed that the area of the body exposed to radiation and the body dose per field are significant factors. Some investigators have thought that the presence of malnutrition decreases the tolerance to radiation therapy. In most instances, however, these conclusions have been derived entirely from clinical observation and subjective impressions. In an effort to demonstrate whether or not malnutrition predisposes to radiation sickness, we have measured the urinary excretion of niacin and riboflavin in a group of patients with malignant disease, before and after x-ray therapy. Since the vitamin deficiencies most prevalent in this area are those of niacin and riboflavin, it was felt that the urinary levels of these substances would give some indication of the patient's general nutrition. A review of the literature reveals no similar study of urinary excretion levels. Material and Method of Study Thirty subjects were taken at random from a group of unselected patients who were receiving x-ray and radium therapy for malignant disease. The group included 22 females and 8 males.