Chang Shih-Chieh, Lai Yi-Chun, Hung Jui-Chi, Chang Cheng-Yu
Division of Chest Medicine, Department of Internal Medicine.
Department of Critical Care Medicine, National Yang-Ming University Hospital, Yi-Lan.
Medicine (Baltimore). 2019 Feb;98(8):e14463. doi: 10.1097/MD.0000000000014463.
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.
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.
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).
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.
同步放化疗（CCRT）相关并发症，如急性放射性食管炎（ARIE），可能导致晚期非小细胞肺癌（NSCLC）患者出现严重发病情况及计划外治疗延迟。我们设计了一项前瞻性随机研究，以评估补充谷氨酰胺（GLN）对预防晚期NSCLC患者CCRT诱导毒性的影响。
2014年9月至2015年9月，60例诊断为NSCLC的患者纳入本研究。30例患者（50%）口服预防性粉状GLN，剂量为10克/8小时。计划靶体积的处方放射剂量为30 Gy，分2 Gy分次给予。终点指标为放射性食管炎、黏膜炎、体重减轻、总生存期和无进展生存期。
60例NSCLC患者中，男性42例，女性18例，平均年龄±标准差为60.3岁±18.2岁（范围44 - 78岁）。中位随访26.4个月（范围10.4 - 32.2个月）时，所有患者对GLN耐受性良好。给予GLN与2级或3级ARIE发生率降低相关（Gln +组与Gln -组分别为6.7%对53.4%；P = 0.004）。补充GLN似乎显著延迟ARIE发病5.8天（18.2天对12.4天；P = 0.027），并降低体重减轻发生率（20%对73.3%；P = 0.01）。
我们的研究表明，口服补充谷氨酰胺对接受CCRT的晚期NSCLC患者预防放射性损伤和体重减轻具有有益作用。
