Yu Hui Ming, Liu Yun Fang, Cheng Yu Feng, Hu Li Kuan, Hou Ming
Department of Radiation Oncology, Qilu Hospital, Medical school, Shandong University, Jinan, Shandong Province 250012, China.
Lung Cancer. 2008 Feb;59(2):219-26. doi: 10.1016/j.lungcan.2007.08.007. Epub 2007 Sep 17.
Radiation induced lung toxicity (RILT) is the main adverse effect in the radiation therapy of lung cancer. However, the optimal management of RILT has not been defined. In this paper, we investigated the effects of rhubarb extract on RILT, pulmonary function (PF), transforming growth factor-beta-1 (TGF-beta1), and interleukin-6 (IL-6) in lung cancer patients treated with radiotherapy.
We conducted a randomized, double-blind, placebo-controlled trial. Eighty consecutive patients were randomly enrolled into two groups: trial group and control group. The trial group received three-dimensional conformal radiation therapy (3D-CRT) plus rhubarb (at a dose of 20 mg kg(-1) once a day) for 6 weeks. The control group received 3D-CRT plus a placebo containing starch for 6 weeks. Plasma TGF-beta1 and serum IL-6 were measured in all patients before, every 2 weeks during, and at 6 weeks after the completion of the treatment. RILT and PF were evaluated at 6 weeks and 6 months after the end of the treatment, respectively. The differences of TGF-beta1, IL-6, RILT, and PF between the two groups were analysed.
The incidence of RILT in the trial group was significantly lower than that in the control group at 6 weeks and 6 months after treatment (32.4% versus 56.7% at week 6, and 27.0% versus 52.8% at month 6, both P<0.05). The plasma TGF-beta1 levels in the trial group were significantly lower than that in the control group during and after the treatment (P<0.05 or 0.01, respectively). The serum IL-6 levels in the trial group were significantly lower than that in the control group during the treatment (all P<0.01). The forced vital capacity (FVC), forced expiratory volume at 1s (FEV1) at 6 weeks and the diffusion capacity for carbon monoxide (DLCO) at 6 months in the trial group were significantly improved compared to the control group (P<0.05 or 0.01, respectively).
The rhubarb extract significantly attenuated RILT and improved PF, probably by decreasing the level of TGF-beta1 and IL-6. These results may be of value for the prophylaxis of RILT, but the exact mechanisms underlying these prophylactic effects remain to be further explored.
放射性肺损伤（RILT）是肺癌放射治疗中的主要不良反应。然而，RILT的最佳治疗方案尚未明确。在本文中，我们研究了大黄提取物对接受放射治疗的肺癌患者的RILT、肺功能（PF）、转化生长因子-β1（TGF-β1）和白细胞介素-6（IL-6）的影响。
我们进行了一项随机、双盲、安慰剂对照试验。连续80例患者被随机分为两组：试验组和对照组。试验组接受三维适形放射治疗（3D-CRT）加用大黄（剂量为20mg/kg，每日1次），共6周。对照组接受3D-CRT加用含淀粉的安慰剂，共6周。在所有患者治疗前、治疗期间每2周以及治疗结束后6周检测血浆TGF-β1和血清IL-6。分别在治疗结束后6周和6个月评估RILT和PF。分析两组之间TGF-β1、IL-6、RILT和PF的差异。
治疗后6周和6个月时，试验组RILT的发生率显著低于对照组（第6周时分别为32.4%和56.7%，第6个月时分别为27.0%和52.8%，P均<0.05）。治疗期间及治疗后，试验组血浆TGF-β1水平显著低于对照组（分别为P<0.05或0.01）。治疗期间试验组血清IL-6水平显著低于对照组（均为P<0.01）。与对照组相比，试验组在6周时的用力肺活量（FVC）、第1秒用力呼气量（FEV1）以及在6个月时的一氧化碳弥散量（DLCO）均显著改善（分别为P<0.05或0.01）。
大黄提取物可能通过降低TGF-β1和IL-6水平，显著减轻RILT并改善PF。这些结果可能对RILT的预防有价值，但这些预防作用的确切机制仍有待进一步探索。
