Risk factors for radiation esophagitis and pneumonitis in esophageal cancer patients with diabetes or hypertension

Abstract

Objective To investigate the risk factors for acute radiation esophagitis andpneumonitis after radiation therapy in esophageal cancer (EC) patients with diabetes or hypertension. Methods A total of 373 EC patients receiving three dimensional conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT) were included in this study. Among these patients, 42 showed concurrent with diabetes and 99 with hypertension. Radiation esophagitis or pneumonitis in patients with or without diabetes, and with or without hypertension were monitored in the 1-year follow up, respectively. Results The prevalence of grade 1, 2, 3 and 4 radiation esophagitis in diabetes and non-diabetes patients was 40.5%, 38.1%, 14.3%, 4.8% and 66.2%, 27.8%, 2.7%, 1.8%, respectively, while that of the grade 1, 2 and 3 radiation pneumonitis in diabetes and non-diabetes patients was 31.0%, 16.7%, 9.5% and 30.8%, 15.7%, 1.2%, respectively. The prevalence of grade 3 or above radiation esophagitis and pneumonitis in patients with diabetes and was significantly higher than those with non-diabetes (χ2=13.573, 12.279, P<0.05). The prevalence of grade 1, 2, 3 and 4 radiation esophagitis in hypertension and non-hypertension patients was 49.5%, 38.4%, 8.1%, 3.0% and 68.2%, 25.5%, 2.6%, 1.8%, respectively, while that of the grade 1, 2 and 3 radiation pneumonitis in hypertension and non-hypertension patients were 30.3%, 18.2%, 5.1% and 31.0%, 15.0%, 1.1%, respectively. The prevalence of grade 3 or above radiation esophagitis and pneumonitis in patients with hypertension was significantly higher than those with non-hypertension (χ2=5.695、5.422, P<0.05). Diabetes is an independent risk factor for grade 3 or above acute radiation esophagitis and pneumonitis. Conclusions Diabetes or hypertension might be risk factors for severe radiation esophagitis and pneumonitis in EC patients receiving radiation therapy. Key words: Diabetes; Hypertension; Esophageal cancer; Radiation esophagitis; Radiation pneumonitis