Abstract
The aim was to defect the exhaled nitric oxide (eNO) prediction value of symptomatic radioactive pneumonia (SRP). 64 cases of lung cancer or esophagus cancer, who had the primary radiotherapy (intensity-modulated radiation therapy), were included from 2015 June to 2016 January. During the following, the patients were divided: the symptomatic radiation pneumonia group (SRP, with the CTCAE v4.0 score > 2) and the asymptomatic radiation pneumonia group (ASRP, with CTCAE v4.0 score ≤ 1). All the patients were measured eNO before and at the end of thoracic radiotherapy and gain the posttherapy eNO value and the eNO ratio (posttherapy eNO value/pretherapy eNO value), then the predictive values of eNO toward SRP were measured using the receiver-operating characteristic (ROC). 17 cases were included in the SRP group and the other 47 were included in the ASRP group. The posttherapy eNO was 29.35 (19~60) bbp versus 20.646 (11~37) (P < 0.001), and the ratio was 1.669 (0.61~3.5) versus 0.920 (0.35~1.5) (P < 0.01) (symptomatic versus asymptomatic). ROC showed that the cutoff value of SRP was 19.5 bbp (posttherapy eNO, area under concentration-time curve (AUC) = 0.879) and 1.305 (eNO ratio, AUC = 0.774), which meant that posttherapy eNO and eNO ratio were useful in finding SRP.
Highlights
Cancer remains the leading cause of death globally
In 1980, Furchgott and his colleagues found that endothelial cells can release a diffusible substance that has the effect of relaxing vascular smooth muscle cells and named this diffusible substance as endothelium-derived relaxing factor (EDRF), which was nitric oxide (NO) [14]
NO contributes to the prevention and treatment of tumors in the radiotherapy process by increasing the cell nucleic acid injury and interrupt intracellular signals [16]
Summary
Cancer remains the leading cause of death globally. The International Agency for Research on Cancer (IARC) recently estimated that 7.6 million deaths worldwide were due to cancer with 12.7 million new cases per year being reported worldwide [1]. Radiation is a physical agent, which is used to destroy cancer cells by damaging the genetic material of cells and blocking their ability to divide and proliferate further which depends on the high-energy radiation [2], which is one of the main methods of modern tumor therapies, due to the annually increased incidence of thoracic malignant tumors, such as thoracic malignant tumors in lung cancer, breast cancer, esophageal cancer, or thymic cancer which all require chest radiotherapy [3]. Chest radiotherapy can cause different levels of radioactive injury in normal lung tissues adjacent to the tumor, which mainly appears early acute inflammatory radiation pneumonia and later radiation pulmonary fibrosis [5]. Radiation pneumonia (RP) mainly manifests as fever, cough, breathing difficulty, or even respiratory failure in severe cases [6], so it seriously restricts the increase of radiation dose, leads to reduced local control of chest tumors, and even interrupts radiation therapy [7]. With the development of radiotherapy technologies, the incidence of RP has been decreased significantly, but it is still about 25% [8], and no effective prediction method has been developed yet
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