Acute Radiation-induced Esophagitis Research Articles

Gut Microbiota Characteristics Are Associated With Severity of Acute Radiation-Induced Esophagitis.

BackgroundAcute radiation-induced esophagitis (ARIE) is one of the most debilitating complications in patients who receive thoracic radiotherapy, especially those with esophageal cancer (EC). There is little known about the impact of the characteristics of gut microbiota on the initiation and severity of ARIE.Materials and MethodsGut microbiota samples of EC patients undergoing radiotherapy (n = 7) or concurrent chemoradiotherapy (n = 42) were collected at the start, middle, and end of the radiotherapy regimen. Assessment of patient-reported ARIE was also performed. Based on 16S rRNA gene sequencing, changes of the gut microbial community during the treatment regimen and correlations of the gut microbiota characteristics with the severity of ARIE were investigated.ResultsThere were significant associations of several properties of the gut microbiota with the severity of ARIE. The relative abundance of several genera in the phylum Proteobacteria increased significantly as mucositis severity increased. The predominant genera had characteristic changes during the treatment regimen, such as an increase of opportunistic pathogenic bacteria including Streptococcus. Patients with severe ARIE had significantly lower alpha diversity and a higher abundance of Fusobacterium before radiotherapy, but patients with mild ARIE were enriched in Klebsiella, Roseburia, Veillonella, Prevotella_9, Megasphaera, and Ruminococcus_2. A model combining these genera had the best performance in prediction of severe ARIE (area under the curve: 0.907).ConclusionThe characteristics of gut microbiota before radiotherapy were associated with subsequent ARIE severity. Microbiota-based strategies have potential use for the early prediction of subsequent ARIE and for the selection of interventions that may prevent severe ARIE.

A novel nomogram containing acute radiation esophagitis predicting radiation pneumonitis in thoracic cancer receiving radiotherapy

BackgroundRadiation-induced pneumonitis (RP) is a non-negligible and sometimes life-threatening complication among patients with thoracic radiation. We initially aimed to ascertain the predictive value of acute radiation-induced esophagitis (SARE, grade ≥ 2) to symptomatic RP (SRP, grade ≥ 2) among thoracic cancer patients receiving radiotherapy. Based on that, we established a novel nomogram model to provide individualized risk assessment for SRP.MethodsThoracic cancer patients who were treated with thoracic radiation from Jan 2018 to Jan 2019 in Shandong Cancer Hospital and Institute were enrolled prospectively. All patients were followed up during and after radiotherapy (RT) to observe the development of esophagitis as well as pneumonitis. Variables were analyzed by univariate and multivariate analysis using the logistic regression model, and a nomogram model was established to predict SRP by “R” version 3.6.0.ResultsA total of 123 patients were enrolled (64 esophageal cancer, 57 lung cancer and 2 mediastinal cancer) in this study prospectively. RP grades of 0, 1, 2, 3, 4 and 5 occurred in 29, 57, 31, 0, 3 and 3 patients, respectively. SRP appeared in 37 patients (30.1%). In univariate analysis, SARE was shown to be a significant predictive factor for SRP (P < 0.001), with the sensitivity 91.9% and the negative predictive value 93.5%. The incidence of SRP in different grades of ARE were as follows: Grade 0–1: 6.5%; Grade 2: 36.9%; Grade 3: 80.0%; Grade 4: 100%. Besides that, the dosimetric factors considering total lung mean dose, total lung V5, V20, ipsilateral lung mean dose, ipsilateral lung V5, and mean esophagus dose were correlated with SRP (all P < 0.05) by univariate analysis. The incidence of SRP was significantly higher in patients whose symptoms of RP appeared early. SARE, mean esophagus dose and ipsilateral mean lung dose were still significant in multivariate analysis, and they were included to build a predictive nomogram model for SRP.ConclusionsAs an early index that can reflect the tissue’s radiosensitivity visually, SARE can be used as a predictor for SRP in patients receiving thoracic radiation. And the nomogram containing SARE may be fully applied in future’s clinical work.

Acute Radiation-induced Esophagitis as a Novel and Early Predictor for Radiation-Induced Pneumonitis: A Real-World Study

Radiation-induced pneumonitis (RP) is a non-negligible and life-threatening complication in patients undergoing thoracic radiation. We have observed that many patients with severe RP (SRP, grade≥2) were accompanied with severe acute radiation-induced esophagitis (SARE, grade≥2) in clinic. The aim of this study was to ascertain the application value of SARE to SRP and establish a novel and visible nomogram model for it. Patients with thoracic cancer who were treated with thoracic radiation from Jan.2018 to Jan.2019 in Shandong Cancer Hospital and Institute were enrolled prospectively. All patients were followed up during and after radiotherapy (RT) to observe the appearance of esophagitis and pneumonitis. Variables were analyzed by univariate and multivariate analysis using the logistic regression model, and a nomogram model was established to predict SRP by "R” version 3.6.0. A total of 123 patients were enrolled (64 esophageal cancer, 57 lung cancer and 2 mediastinal cancer) in this study prospectively. With a median follow-up of 3.3 months (range 1–14.2 months), RP grades of 0, 1, 2, 3, 4 and 5 occurred in 29, 57, 31, 0, 3 and 3 patients, respectively. SRP appeared in 37 patients (30.1%). In univariate analysis, SARE was shown to be a significant predictive factor for SRP (P < 0.001). The incidence of SRP in different grades of ARE were as follows: Grade 0-1:6.52%; Grade 2: 36.92%; Grade 3: 80.00%; Grade 4: 100%. Besides that, the dosimetric factors considered total lung mean dose, total lung V5, V20; ipsilateral lung mean dose, ipsilateral lung V5, and mean esophagus dose to be correlated with SRP (all P < 0.005) in univariate analysis. The incidence of SRP was significantly higher in patients whose symptoms of RP appeared early. SARE (HR 34.408, P = 0.001), mean esophagus dose and ipsilateral mean lung dose were still significant in multivariate analysis, and they were included to build a predictive nomogram model for SRP. SARE was the first intuitive index that can reflect the radiation sensitivity of normal tissue visually. It could be a significant predictor to SRP for patients receiving thoracic radiation, which can be earlier and easier than previously reported laboratory or clinical indicators. And the nomogram model could assist in doctor’s decision and guide to make personalized radiation dose prescription.

Efficacy of oral epigallocatechin-3-gallate solution administration during radiotherapy for non-small-cell lung cancer patients: A long-term observational study

ObjectiveSeveral studies have found that epigallocatechin-3-gallate (EGCG) can alleviate acute radiation-induced esophagitis, inhibit pulmonary inflammation and fibrosis, and reduce the severity of cardiovascular disease. Therefore, this study was aimed at exploring the influence of EGCG on late radiation toxicity in the heart, esophagus, and lungs among patients with locally advanced lung cancer. MethodsThe patients were divided into an EGCG group and a control group, the groups received EGCG and symptomatic treatment, respectively. The Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer Late Radiation Morbidity Scoring Scheme was used to determine the late toxicity scores. Tumor responses were evaluated by chest computed tomography (CT), based on the Response Evaluation Criteria in Solid Tumors version 1.1. ResultsWe retrospectively analyzed 74 patients treated at our hospital from September 2012 to September 2016 (37 patients received EGCG and 37 received supportive treatment). The late toxicity scores of the EGCG group decreased compared to those of the control group. An obvious clinical significance was observed for the oral EGCG solution in the treatment and prevention of late cardiac, esophageal, and pulmonary toxicity. However, no significant difference was found (P ​> ​0.05). The tumor response rates were similar in the two groups. Moreover, there was no difference in progression-free survival (PFS) between the groups (P ​> ​0.05). ConclusionOral EGCG solution might alleviate radiation-induced late cardiac, esophageal, and pulmonary toxicity but has no significant effect on the tumor response rate and PFS following radiotherapy.

A prospective, three-arm, randomized trial of EGCG for preventing radiation-induced esophagitis in lung cancer patients receiving radiotherapy

Background and purposeThis trial investigated whether epigallocatechin-3-gallate (EGCG), a radioprotector, could be effective in the prevention and treatment of acute radiation-induced esophagitis (ARIE). Methods and materialsThis is a phase II study of EGCG combined with chemoradiation in unresectable stage III non-small-cell lung cancer or limited stage small cell lung cancer. Patients were randomized into a prophylactic EGCG group (arm A), a therapeutic EGCG group after the occurrence of esophagitis (arm B) or conventional therapy group (arm C). Esophagitis grades, pain and dysphagia scores were recorded weekly. Adjusted esophagitis index (AEI), pain index (API) and dysphagia index (ADI) were calculated to reflect changes in esophagitis grade, pain score and dysphagia score throughout treatment. ResultsA total of 83 patients were eligible for toxicity analysis (arm A vs arm B vs arm C: N = 28:27:28). There was no significant difference in the baseline characteristics among three arms of the patients. The difference in the maximum esophagitis grade among three groups was statistically significant (P = 0.004). The maximum ARIE for patients with EGCG was significantly lower than for those with conventional therapy. The mean AEI of arm A was lower than that of arm B, while the mean AEI of arm C was the highest (arm A vs arm B, P = 0.028; arm B vs arm C, P = 0.002). Furthermore, API and ADI were significantly lower in patients receiving EGCG than in conventionally treated patients. ConclusionThe application of EGCG could effectively alleviate acute radiation esophagitis in advanced lung cancer without obvious side effects. Prophylactic application of EGCG had a slight advantage over therapeutic use in treatment of acute esophagitis.

Oral glutamine supplements reduce concurrent chemoradiotherapy-induced esophagitis in patients with advanced non-small cell lung cancer.

Background:Complications related to concurrent chemoradiotherapy (CCRT) such as acute radiation-induced esophagitis (ARIE) may cause significant morbidity and unplanned treatment delays in patients with advanced non-small cell lung cancer (NSCLC). We designed a prospective randomized study to assess the impact of glutamine (GLN) supplementation in preventing CCRT-induced toxicities of advanced NSCLC patients.Methods:From September 2014 to September 2015, 60 patients diagnosed with NSCLC were included to the study. Thirty patients (50%) received prophylactic powdered GLN orally at a dose of 10 g/8 h. The prescribed radiation dose to the planning target volume was 30 Gy in 2-Gy fractions. The endpoints were radiation-induced esophagitis, mucositis, body weight loss, overall survival and progression-free survival.Results:The 60 patients with NSCLC included 42 men and 18 women with a mean age ± standard deviation of 60.3 years ± 18.2 (range, 44–78 years).At a median follow-up of 26.4 months (range 10.4–32.2), all patients tolerated GLN well. A administration of GLN was associated with a decrease in the incidence of grade 2 or 3 ARIE (6.7% vs 53.4% for Gln+ vs Gln-; P = .004). GLN supplementation appeared to significantly delay ARIE onset for 5.8 days (18.2 days vs 12.4 days; P = .027) and reduced incidence of weight loss (20% vs 73.3%; P = .01).Discussion:Our study suggests a beneficial effect of oral glutamine supplementation for the prevention from radiation-induced injury and body weight loss in advanced NSCLC patients who receiving CCRT.

Survival analysis of preoperative involved-field irradiation with concurrent chemotherapy for patients with Siewert′s type II and III adenocarcinoma of esophagogastric junction

Objective To analyze the clinical efficacy, toxicity and survival prognosis of patients diagnosed with Siewert type Ⅱ and Ⅲ locally advanced adenocarcinoma of esophagogastric junction (AEG) undergoing preoperative involved-field irradiation with concurrent chemotherapy. Methods A total of 45 cases were recruited in this prospective clinical trial. Prior to surgery, patients received 2 cycles of chemotherapy with XELOX and concurrent radiotherapy (a total of 45 Gy in 25 fractions, 5 times weekly). After 6-8 weeks, they underwent surgical resection. After the surgery, patients received 6 cycles of adjuvant chemotherapy. The completion of preoperative neoadjuvant chemoradiotherapy, postoperative pathological status, TNM down-staging effect and adverse reactions were observed. Kaplan-Meier method was applied to estimate survival analysis. Results All 45 patients completed preoperative neoadjuvant chemoradiotherapy. Among them, 39 patients completed 2 cycles of chemotherapy, and 6 patients completed 1 cycle of chemotherapy. The median time of surgical interval was 6 weeks. The R0 resection rate was 96%.The pathological complete response (pCR) rate was 22%. The TNM down-staging rate was 69%.The incidence of acute radiation-induced esophagitis or gastritis was 44% and the incidence of radiation-induced pneumonitis was 7%. The incidence of grade 1-3 leukocytopenia, thrombocytopenia and neutropenia was 78%, 47% and 44%, respectively. In terms of gastrointestinal reactions, the incidence of nausea, vomiting and loss of appetite was 62%, 24% and 71%, respectively. No hematologic or nonhematologic adverse effects was observed at grade 4 or 5.The median follow-up time was 30 months. 11 patients died of cancer, 1 patient was treatment-related death in the perioperative period and 1 patient died of pneumonia. The 1-, 2-and 3-year progression-free survival (PFS) rates were 90%, 70% and 67%, respectively. The 1-, 2-and 3-year overall survival rates were 95%, 80% and 75%, respectively. The 1-, 2-and 3-year local control rates were 95%, 84% and 84%, respectively. The 1-, 2-and 3-year distant metastasis rates were 7%, 25% and 25%, respectively. Conclusions Preoperative involved-field irradiation with concurrent chemotherapy yields relatively high clinical efficacy and is well tolerated by patients with Siewert type Ⅱ and Ⅲ locally advanced AEG.Patients are recommended to receive 4 cycles of adjuvant chemotherapy following neoadjuvant chemoradiotherapy and surgery. Key words: Adenocarcinoma of esophagogastric junction/radiotherapy; Adenocarcinoma of esophagogastric junction/chemotherapy; Prognosis; Drug tolerance

EP-1704: How efficacious is Ziverel® for symptomatic relief of acute radiation-induced esophagitis?

EP-1704: How efficacious is Ziverel® for symptomatic relief of acute radiation-induced esophagitis?

How Efficacious is Ziverel® for Symptomatic Relief of Acute Radiation-Induced Esophagitis? Retrospective Study of Patients Receiving Oncologic Treatment

How Efficacious is Ziverel® for Symptomatic Relief of Acute Radiation-Induced Esophagitis? Retrospective Study of Patients Receiving Oncologic Treatment

Effect of compound Zhuye Shigao Granule ( ) on acute radiation-induced esophagitis in cancer patients: A randomized controlled trial.

To observe the efficacy and safety of the Chinese medicine (CM) Compound Zhuye Shigao Granule (, CZSG) on acute radiation-induced esophagitis (ARIE) in cancer patients. In a blinded, randomized, Kangfuxin Solution (, KFX)-controlled, single-centre clinical trial, 120 patients with lung, esophagus or mediastinal cancer were prospectively enrolled and assigned to the treatment group (60 cases) and control group (60 cases) by the random number table method. All patients received concurrent or sequential radiotherapy (2 Gy per day, 5 times per week, for 4 weeks) and were treated for 4 weeks since the radiation therapy. Patients in the treatment group were given 12 mg CZSG orally, thrice daily, while patients in the control group were given 10 mL KFX orally, thrice daily. The major indicators were observed, including the incidence and grade of esophagitis, time of occurrence and duration. Minor indicators were changes of CM symptoms, weight and Karnofsky Performance Status (KPS) Scale during 4 weeks from the beginning, recorded once a week. Blood routine examination and hepatorenal function were detected at the 2nd and 4th weeks. The incidence and grade of ARIE were significantly decreased in the treatment group compared with the control group (P<0.05). CZSG appeared to significantly delay the time of ARIE occurrence and reduce the duration compared with KFX (P<0.05). The scores of CM symptoms, KPS and weight were improved significantly in the treatment group compared with the control group (P<0.05). There were no blood routine and hepatorenal function abnormal or obvious side-effects in both groups. Hemoglobin was improved and neutrophil and interleukin 6 were decreased in both groups after 4-week treatment compared with before treatment (P<0.05), and there was no significant difference between the two groups (P>0.05). CZSG can decrease the incidence and grade of ARIE, delay the time of occurrence, reduce duration and alleviate the damage of ARIE. It is safe and effective in the prevention and cure of ARIE.

Oral Epigallocatechin-3-Gallate Treats Acute Radiation-Induced Esophagitis in Patients With Esophageal Cancer Receiving Chemoradiation Therapy/Radiation Therapy

Patients with esophageal cancer receiving definitive chemo-radiation therapy/radiation therapy often develop acute radiation-induced esophagitis (ARIE) that may interference with quality of life and lead to unplanned treatment interruptions. Our previous trials preliminarily showed that EGCG could be a promising strategy in the treatment of ARIE when esophagus received low dose radiation (mean dose, 14.9Gy) in lung cancer. We hypothesize that EGCG is safe and effective in treating ARIE in esophageal cancer patients with higher mean esophagus dose. All the patients underwent three dimensional conformal or intensity modulation radiated therapy (total dose, 50.4-60Gy). Eligible patients were also required to have met the following criteria: age≥18 years; ECOG PS 0-1; no prior radiation to the thorax; concurrent chemo-radiotherapy or radiotherapy only. EGCG was administrated once ARIE appeared. EGCG was given with the concentration of 440μmol/L during radiotherapy and additionally 2 weeks after radiotherapy. RTOG score, dysphasia and pain related to esophagitis were recorded every week. Thirty-seven patients with stage IIB and III esophageal cancer were enrolled in this study. 81.1% patients received concurrent chemotherapy. Two cases stopped the radiotherapy because of arrest of bone marrow or infection, thus EGCG treatment was also stopped. Other 4 cases also stopped EGCG treatment because of their personal reasons. The median dose of the appearance of ARIE was 28Gy (range, 12–48 Gy). In comparison to the original, the RTOG score in the 1st, 2nd, 3rd, 4th, 5th week after EGCG prescription and the 1st, 2nd week after radiotherapy decreased significantly (P = 0.161, 0.012, 0.022, 0.042, 0.076, 0.000, 0.000, respectively). The pain score of each week was significantly lower than the baseline (P = 0.000, 0.000, 0.000, 0.000, 0.012, 0.000, 0.000, respectively). The EGCG solution was generally well-tolerated, but most patients complained of its nauseating taste. Complete response after chemoradiotherapy/radiotherapy for esophageal cancer obtained in 4 patients, partial response in thirteen, stable disease in thirteen, and progression in one. This study confirmed that the oral administration of EGCG is an effective and safe method to deal with ARIE, even when the esophagus received more than 50.4 Gy radiation. A phase III randomized controlled trial is expected to further corroborate the consequence of EGCG in ARIE treatment in patients with esophageal cancer.

The effects of oral glutamine on clinical and survival outcomes of non-small cell lung cancer patients treated with chemoradiotherapy

To assess the efficacy of oral glutamine (Gln) supplementation on clinical and survival outcomes of patients with locally advanced non-small cell lung cancer (LA-NSCLC). Between 2010 and 2014, 122 stage III NSCLC patients were retrospectively analyzed. All patients received curative intent chemoradiotherapy (CRT). Prophylactic oral Gln powder was applied at a dose of 10g tid. Effect of oral Gln supplementation in the prevention of severe (≥grade 2-3) acute radiation-induced esophagitis (ARE) and weight loss, and their relation with overall survival (OS) and disease-free survival (DFS) was measured. Median follow-up was 13.14 months (range; 1.97-55.36). Fifty-six (46%) patients had received oral Gln. Severe ARE was significantly lower in Gln-supplemented group (30% vs 70%; p=0.002). Gln-free patients demonstrated a higher weight loss (p=0.0001). In multivariate analysis hemoglobin (hb) level (<12g/dL; p=0.01) and nodal stage (N3; p=0.01) were poor prognostic factors that affect OS; Weight loss (p=0.06) and Gln-free (p=0.05) reached nearly significant levels that poorly affect OS. Similarly, nodal stage (N3, p=0.014) and Gln-free (p=0.035) were poor prognostic factors that affect DFS. Weight loss (≥2%, p=0.06) and hb level (<12g/dL, p=0.07) reached borderline significance that poorly affect DFS. Nodal stage (N3) was the only poor prognostic factor that affect OS and DFS in univariate analysis (p=0.01, p=0.009; respectively). Oral Gln supplementation significantly reduces grade 2-3 esophagitis and weight loss and also no negative impact on tumor control and survival outcomes in patients with LA-NSCLC.

Clinical research of raltitrexed plus nedaplatin combined with concurrent radiotherapy for loco-regional recurrence of esophageal carcinoma after surgery

Objective To evaluate the efficacy, safety and prognostic factors of raltitrexed plus nedaplatin combined with concurrent radiotherapy for loco-regional recurrence of esophageal squamous cell carcinoma after surgery. Methods Between October 2011 and March 2015, 54 patients with loco-regional recurrence of esophageal carcinoma after surgery in Sichuan Cancer Hospital and Institute were treated with raltitrexed plus nedaplatin combined with concurrent radiotherapy. The patients were irradiated with a dose of 60-66 Gy in 30-33 fractions. At least 2 cycles of concurrent chemotherapy were administered during radiotherapy, with 3 mg/m2 raltitrexed and 80 mg/m2 nedaplatin on the first day, every 21 days. Results The complete response rate was 7.4% (4/54), and the partial response rate was 70.4% (38/54). The total response rate was 77.8%. The 1-, 2-, 3-year survival rates and median survival time were 62.9%, 27.5%, 12.2% and 18.0 months, respectively. The 1-, 2-year progression-free survival rates and median progression-free survival time were 33.9%, 12.6% and 8.0 months, respectively. In univariate analysis, the short-time curative effect (χ2=3.935, P=0.047), the site of recurrence (χ2=11.280, P=0.001), postoperative stage (χ2=5.141, P=0.023) were related to the survival rate. COX multiple factors regression analysis showed that the short-time curative effect (χ2=6.044, P=0.014), the site of recurrence (χ2=7.019, P=0.013), postoperative stage (χ2=3.404, P=0.036) were independent prognostic factors for survival. The incidence rates of ≥grade 3 leukopenia, hypochromia, thrombocytopenia were 24.1%, 3.7% and 13.0%, respectively. Gastrointestinal adverse reactions were grade 1-2 nausea and vomiting and acute diarrhea, and the incidence rates were 18.5% and 7.4%, respectively. The incidence rates of grade 1-2 acute radiation-induced esophagitis and acute radiation-induced pneumonia were 27.8% and 20.4%, respectively. Conclusion Raltitrexed plus nedaplatin combined with concurrent radiotherapy can enhance the response rate and prolong the survival of patients with loco-regional recurrence of esophageal carcinoma after surgery, which has mild toxicity and is worthy of randomized controlled clinical study. After treatment, the recent curative effect is good, and the prognosis of patient with recurrence of single part and early postoperative pathologic staging is better. Key words: Esophageal neoplasms; Neoplasm recurrence, local; Radiotherapy, intensity-modulated; Prognosis; Raltitrexed

Long term survival analysis of middle and lower thoracic esophageal carcinoma of stage T4N (+ ) treated with 3DRT

Objective To observe the long-term survival and adverse reactions in patients with stage T4N (+ ) Ⅲ middle and lower thoracic esophageal carcinoma undergoing intensity-modulated radiotherapy (IMRT). Methods From 2004 to 2010, 300 patients with stage T4N (+ ) Ⅲ middle and lower thoracic esophageal carcinoma, consisting of 202 treated with three-dimensional conformal radiotherapy (3DCRT) and 98 treated with IMRT, were enrolled as subjects. All patients received conventionally fractionated radiotherapy with a prescribed dose of 60 Gy. The long-term survival and adverse reactions were compared between patients treated with the two different radiotherapy regimens. The survival rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test. Results The 5-and 7-year sample sizes were 239 and 120, respectively. The 3DCRT group had significantly lower 1-, 3-, 5-, and 7-year local control (LC) and overall survival (OS) rates than the IMRT group (64.4% vs. 68.3%, 40.6% vs. 55.3%, 38.3% vs. 51.9%, 34.2% vs. 51.9%, P=0.048; 54.5% vs. 63.3%, 19.8% vs. 34.7%, 14.7% vs. 24.4%, 10.9% vs. 20.3%, P=0.013). The stratified analysis showed that for patients older than 65 years, with the length of esophageal lesion>8.0 cm before radiotherapy, the largest diameter of esophageal lesion in computed tomography image>4.6 cm, gross tumor volume (GTV)>60 cm3, metastases to adjacent tissues or organs, stage N2, and without chemotherapy, the IMRT group had a significantly higher OS rate than the 3DCRT group (P=0.022, 0.003, 0.022, 0.034, 0.016, 0.044, 0.047). The GTVDmin and GTVD100 were significantly higher in the IMRT group than in the 3DCRT group (P=0.000, 0.000), while the Dmax of the spinal cord was significantly lower in the IMRT group than in the 3DCRT group (P=0.000). Compared with the 3DCRT group, the IMRT group had a significantly higher incidence of acute radiation-induced esophagitis, particularly grade 1-2 esophagitis (P=0.000). The mortality rate caused by local tumor was significantly higher in the 3DCRT group than in the IMRT group (P=0.039). Conclusions In the treatment of locally advanced middle and lower thoracic esophageal carcinoma, IMRT is safe and effective; it significantly improves the LC rate and long-term survival without severe toxicity to normal tissues. The results of this retrospective study need to be confirmed by prospective randomized controlled studies. Key words: Esophageal neoplasms/radiotherapy; Radiotherapy, three-dimensional; Radiotherapy, intensity-modulated; Prognosis

A prospective phase II trial of EGCG in treatment of acute radiation-induced esophagitis for stage III lung cancer

BackgroundAcute radiation-induced esophagitis (ARIE) is one of main toxicities complicated by thoracic radiotherapy, influencing patients’ quality of life and radiotherapy proceeding seriously. It is difficult to be cured rapidly so far. Our phase I trial preliminarily showed that EGCG may be a promising strategy in the treatment of ARIE. Materials and methodsWe prospectively enrolled patients with stage III lung cancer from the Shandong Tumor Hospital & Institute in China from January 2013 to September 2014. All patients received concurrent or sequential chemo-radiotherapy, or radiotherapy only. EGCG was administrated once ARIE appeared. EGCG was given with the concentration of 440μmol/L during radiotherapy and additionally two weeks after radiotherapy. RTOG score, dysphagia and pain related to esophagitis were recorded every week. ResultsThirty-seven patients with stage IIIA and IIIB lung cancer were enrolled in this trial. In comparison to the original, the RTOG score in the 1st, 2nd, 3rd, 4th, 5th week after EGCG prescription and the 1st, 2nd week after radiotherapy decreased significantly (P=0.002, 0.000, 0.000, 0.001, 0.102, 0.000, 0.000, respectively). The pain score of each week was significantly lower than the baseline (P=0.000, 0.000, 0.000, 0.000, 0.006, 0.000, 0.000, respectively). ConclusionThis trial confirmed that the oral administration of EGCG is an effective and safe method to deal with ARIE. A phase III randomized controlled trial is expected to further corroborate the consequence of EGCG in ARIE treatment.

Oral glutamine supplementation reduces radiotherapy- induced esophagitis in lung cancer patients.

The purpose of this study was to assess the the efficacy of oral glutamine (GLN) in prevention of acute radiation-induced esophagitis in patients with lung cancer and determine the predictive role of clinical and dosimetric parameters. Thirty-two patients diagnosed with lung cancer were studied prospectively. Sixteen patients (50%) received prophylactic powdered GLN orally in doses of 10g/8h. Patients were treated 2 Gy per fraction daily, 5 days a week. We evaluated the grading of esophagitis daily at the end of each fraction of each treatment day until a cumulative dose of 50 Gy was reached. The primary end point was radiation-induced esophagitis. All patients tolerated GLN well. Toxicity grade, weight loss, serum cytokine levels and esophageal transit times exhibited statistically significant improvement in the GLN receiving group. GLN suppressed the inflammation related to the disease and treatment and reduced toxicity with statistical significance. This study suggests a benefical role of oral GLN use in prevention and/or delay of radiation-induced esophagitis, in terms of esophageal transit time and serum immunological parameters, as well as weight loss.

Effects of Huisheng Koufuye in prevention and treatment of acute radiation-induced esophagitis

Effects of Huisheng Koufuye in prevention and treatment of acute radiation-induced esophagitis

Pain-relieving effect of a compound isolated from white peony root oral liquid on acute radiation-induced esophagitis

Acute radiation‑induced esophagitis (ARIE) is a common complication of radiotherapy. The aim of this study was to clarify the molecular mechanism of pain relief by the compound of white peony root oral liquid (cWPROL) in ARIE. An animal model of ARIE was established and either cWPROL or a mixture of lidocaine, dexamethasone and gentamycin (mLDG) was administered. We indirectly observed rat symptoms of pain by recording the weight of food and the volume of water consumed by the rats, along with changes in body weight. Additionally, the expression levels of substance P (SP) in the esophageal tissues were detected by immunohistochemistry. It was demonstrated that cWPROL was able to release the pain of ARIE by decreasing the expression of SP; this may be one of the molecular mechanisms via which cWPROL induces pain relief.

Efficacy of Glutamine in the Prevention of Oral Mucositis and Acute Radiation-Induced Esophagitis: A Retrospective Study

Glutamine is a nutraceutic with antioxidant and immune functions that can protect from adverse effects associated with radiation therapy (RT). The aim of this study was to test whether oral glutamine prevents oral mucositis (OM) or acute radiation-induced esophagitis (ARIE) and favors nutritional status. This retrospective, cohort study included patients treated with RT for cancer on head and neck (HN) or chest areas during the 2008–2010 period. Data on glutamine treatment (initiated before RT, during RT, or no glutamine), appearance of mucositis (according to World Health Organization criteria), weight loss (WL) during RT, moderate [body mass index (BMI) <20.5 kg/m2 or WL > 5%) or severe (BMI < 18.5 kg/m2 or WL > 10%) malnutrition, and nutritional support were collected. Quantitative data were compared using Student's t-test and analysis of variance, and qualitative data using the chi-square test. The risk difference was calculated with its 95% confidence interval (95% CI). The sample included 117 patients. Overall, glutamine was associated with a significant reduction of mucositis, WL, and enteral nutrition. The risk difference for developing OM in patients receiving glutamine when compared with controls was -9.0% (95% CI = −18.0% to −1.0%), and for ARIE it was −14.0% (95% CI = −26.0% to −1.0%). More of the patients not receiving glutamine developed severe malnutrition when compared with those receiving this supplement, but there were no differences in other outcomes such as interruption of RT, hospitalization, use of opioid analgesics, or death during RT. Glutamine may have a protective effect during RT, reducing the risk and severity of OM and ARIE, preventing weight loss, and reducing the need for nutritional support. Prospective trials are required.

Influence of oral glutamine supplementation on survival outcomes of patients treated with concurrent chemoradiotherapy for locally advanced non-small cell lung cancer

BackgroundGlutamine (Gln) supplementation during concurrent chemoradiotherapy (C-CRT) effectively reduces the incidence and severity of acute radiation-induced esophagitis (RIE). However, there are concerns that Gln might stimulate tumor growth, and therefore negatively impact the outcomes of anticancer treatment. We retrospectively investigated the effect of co-administration of oral Gln during C-CRT on survival outcomes of patients with stage IIIB non-small cell lung carcinoma (NSCLC). We additionally evaluated role of oral Gln in preventing C-CRT-induced weight change, acute and late toxicities.MethodsThe study included 104 patients: 56 (53.8%) received prophylactic powdered Gln (Gln+) orally at a dose of 10 g/8 h and 48 (46.2%) did not receive Gln (Gln-) and served as controls. The prescribed radiation dose to the planning target volume was 66 Gy in 2-Gy fractions. Primary endpoints of progression-free survival (PFS), local/regional progression-free survival (LRPFS), and overall survival (OS) were correlated with status of Gln supplementation.ResultsOral Gln was well tolerated except for mild nausea/vomiting in 14 (25.0%) patients. There was no C-CRT-related acute or late grade 4–5 toxicity. Administration of Gln was associated with a decrease in the incidence of grade 3 acute radiation-induced esophagitis (RIE) (7.2% vs. 16.7% for Gln+ vs. Gln-; p=0.02) and late-RIE (0% vs. 6.3%; p=0.06), a reduced need for unplanned treatment breaks (7.1% vs. 20.8%; p=0.04), and reduced incidence of weight loss (44.6% vs. 72.9%; p=0.002). At a median follow-up of 24.2 months (range 9.2-34.4) the median OS, LRPFS, and PFS for Gln+ vs. Gln- cohorts were 21.4 vs. 20.4 (p=0.35), 14.2 vs.11.3 (p=0.16), and 10.2 vs. 9.0 months (p=0.11), respectively.ConclusionIn our study, supplementation with Gln during C-CRT had no detectable negative impact on tumor control and survival outcomes in patients with Stage IIIB NSCLC. Furthermore, Gln appeared to have a beneficial effect with respect to prevention of weight loss and unplanned treatment delays, and reduced the severity and incidence of acute- and late-RIE.