Dosimetric risk factors for radiation esophagitis in patients with breast cancer following regional nodal radiation

BACKGROUND Radiation esophagitis(RE)is one of the most common clinical symptoms of regional lymph node radiotherapy for breast cancer.However,there are fewer studies focusing on RE caused by hypofractionated radiotherapy(HFRT).AIM To analyze the clinical and dosimetric factors that contribute to the development of RE in patients with breast cancer treated with HFRT of regional lymph nodes.METHODS Between January and December 2022,we retrospectively analysed 64 patients with breast cancer who met our inclusion criteria underwent regional nodal intensity-modulated radiotherapy at a radiotherapy dose of 43.5 Gy/15F.RESULTS Of the 64 patients in this study,24(37.5%)did not develop RE,29(45.3%)developed grade 1 RE(G1RE),11(17.2%)developed grade 2 RE(G2RE),and none developed grade 3 RE or higher.Our univariable logistic regression analysis found G2RE to be significantly correlated with the maximum dose,mean dose,relative volume 20-40,and absolute volume(AV)20-40.Our stepwise linear regression analyses found AV30 and AV35 to be significantly associated with G2RE(P<0.001).The optimal threshold for AV30 was 2.39 mL[area under the curve(AUC):0.996;sensitivity:90.9%;specificity:91.1%].The optimal threshold for AV35 was 0.71 mL(AUC:0.932;sensitivity:90.9%;specificity:83.9%).CONCLUSION AV30 and AV35 were significantly associated with G2RE.The thresholds for AV30 and AV35 should be limited to 2.39 mL and 0.71 mL,respectively.

Study on pharmacodynamics and mechanism of nano-Kuiyangye in treating radiation esophagitis in rats

Objective:To explore the curative effect of nano-Kuiyangye on radiation esophagitis in Wistar rats,and to explore its possible mechanism.Methods:Wistar rats were irradiated locally with 30Gy rays to establish an animal model of radiation esophagitis in rats.After irradiation,nano-Kuiyangye,traditional Chinese medicine ulcer solution,Kangfuxin solution,nano-hydrotalcite matrix,and distilled water were used to intervene continuously for 7 d,during which the body weight and food intake of the rats were recorded.On day 7,blood was collected from the abdominal aorta under anesthesia,and the serum was obtained by centrifugation.The expression levels of pain-related factors prostaglandin-2(PGE-2),substance P(SP),and calcitonin gene-related peptide(CGRP)were detected by ELISA.Rats were sacrificed after blood collection,and full-length esophageal tissues were taken.Hematoxylin-eosin(HE)staining was performed to analyze the pathological changes of the rat esophagus,and Western Blotting was used to detect the expression of nuclear factor-κB(NF-κB)inflammatory protein.Results:Compared with the control group,the total food intake and body weight of the rats within 7 d after modeling were significantly decreased(P<0.05),and the expressions of pain-related factors PGE-2,SP,and CGRP were higher than those of the control group(P<0.05).,the esophageal pathological damage score increased(P<0.05),and the expression of NF-κB inflammatory protein increased(P<0.05);after treatment,the total food intake of the rats in the nano-Kuiyangye intervention group within 7 days after modeling was higher than that in other groups(P<0.05),the expressions of pain-related factors PGE-2,SP,and CGRP were lower than those in the model group(P<0.05),the esophageal pathological damage score was lower(P<0.05),and the expression of NF-κB inflammatory proteins was lower(P<0.05).Conclusion:Nano-Kuiyangye increases the food intake of rats with radiation esophagitis,reduces esophageal tissue damage,and reduces the concentration of serum pain factors;the anti-inflammatory effect of nano-Kuiyangye may be related to the reduction of NF-κB inflammatory factor levels.

Clinical Evaluation of Yangyin Qingre Shengji Decoction(养阴清热生肌汤)in Preventing and Treating Acute Radiation Esophagitis

Objective:To explore the prevention and treatment effect of Yangyin Qingre Shengji Decoction(养阴清热生肌汤)on acute radiation esophagitis.Methods:From May 2020 to February 2021,60 patients with malignant tumor who underwent radiotherapy were selected as the research objects.They were divided into two groups by odd and even number drawing,30 cases in the control group and 30 cases in the observation group.The control group took mixed solution orally,while the observation group took Yangyin Qingre Shengji Decoction.The clinical effects,occurrence time,duration,grading of acute radiation esophagitis and TCM syndrome scores of dry mouth and constipation were compared between the two groups.Results:The effective rate of the observation group was significantly higher than that of the control group(P<0.05);Compared with the control group,the time of acute radiation esophagitis was prolonged and the duration of symptoms was shortened in the observation group(P<0.05);The incidence of above gradeⅡin the observation group was significantly lower than that in the control group,and the incidence of below gradeⅠwas significantly higher than that in the control group(P<0.05);There was no significant difference in the scores of dry mouth and constipation between the two groups before treatment(P>0.05),the scores of the two groups were decreased after treatment,and the observation group was lower than the control group(P<0.05).Conclusion:Yangyin Qingre Shengji Decoction(养阴清热生肌汤)has a positive effect on prevention and treatment of acute radiation esophagitis in patients with malignant tumor undergoing radiotherapy,which can be popularized.

Effect of Modified Zhuye Shigao Decoction(加味竹叶石膏汤) and Its Components on Preventing Radiation Esophagitis of Rats

Objective： To investigate the effect of Modified Zhuye Shigao Decoction （加味竹叶石膏汤, MZSD） and its components on preventing radiation esophagitis of rats. Me,otis： One hundred Wistar rats were randomly divided into 5 groups, including the control group, radiation model group, MZSD group, Zhuye Shigao Decoction （竹叶石膏汤, ZSD） group, and added ingredients group, 20 rats in each group. The model of radiation esophagitis of rat was established by once local radiation of 40 Gy （330 Mu/min） with a high energy linear accelerator. The administration of Chinese medicine was continued for 14 days from 7 days before radiation application in the three treatment groups. On the 7th and 14th day, the serum was isolated and the levels of inflammatory cytokines tumor necrosis factor （TNF-α）, interleukin 1 β （IL-1 β） and IL-8 were tested. The pathological slices of esophagus were obtained, and the pathological changes were observed. During the whole process, weight and food intake were recorded each day. Resale： On the 7th day after radiation, the esophagus of rats in the MZSD group was almost intact, and the pathological injury score was significantly lower than that of the radiation model group, ZSD group and added ingredients group （P〈0.01）. Compared with the control group, the body weight and food intake of rats in the radiation model group were significantly decreased, and the levels of TNF-α, IL-1 β and IL-8 were significantly increased （P〈0.05 or P〈0.01）, while the MZSD group showed a significant increase in body weight and food intake, and a significant decrease in the levels of TNF- α, IL-1 β and IL-8 compared with the radiation model group, ZSD group and added ingredients group （P〈0.05 or P〈0.01）. Conclusion： MZSD prevents the development of radiation esophagitis probably by inhibiting the generation and release of the inflammatory cytokines TNF- α, IL-1βand iL-8.