Eom Keun-Yong, Wee Chan Woo, Song Changhoon, Kim In Ah, Kim Jae-Sung, Kim Kidong, Suh Dong Hoon, No Jae Hong, Kim Yong Beom, Park Jeong Su
Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Clin Transl Radiat Oncol. 2021 Jun 9;29:60-64. doi: 10.1016/j.ctro.2021.05.010. eCollection 2021 Jul.
We investigated whether serum cytokines including Interleukin (IL)-1β, IL-6 and tumor necrosis factor alpha (TNFα) are increased during pelvic chemoradiotherapy (CRT) in patients with gynecologic malignancies, and sought to identify prognostic factors for the development of diarrhea during pelvic CRT.
Patients with cervical or endometrial cancer receiving postoperative pelvic CRT were eligible for this prospective study. Patients were evaluated weekly during CRT for symptoms, including diarrhea and constipation. Serum cytokine levels were measured using immunoassays 1 week before CRT, and at week 3 and 5-6 during CRT. Radiotherapy-related parameters such as mean dose, minimum dose, and maximum dose to the small bowel were also analyzed. Multivariate logistic regression analysis was used to assess factors associated with development of enteritis symptoms.
Twenty-six patients were enrolled, all of whom were eligible for symptom and dosimetric parameter evaluation; 24 were eligible for cytokine level measurement. Cytokine levels did not differ between patients with and without diarrhea before CRT. IL-6 levels increased during CRT, and were significantly higher in patients with diarrhea ≥grade 2 than in those with grade 0-1 at week 5-6 (6.771 ± 2.657 pg/mL vs. 3.396 ± 0.499 pg/mL, p = 0.046). Serum IL-1β and TNFα levels did not change during CRT. Diarrhea before CRT and the maximum dose to the small bowel were independent prognostic factors for CRT-induced diarrhea in the multivariate analysis.
There was an increase of serum IL-6 levels in patients with ≥grade 2 diarrhea during pelvic CRT. Serum IL-1β and TNFα levels did not change during CRT. Radiotherapy-related and clinical factors affect the development of diarrhea during pelvic CRT.
我们研究了妇科恶性肿瘤患者盆腔放化疗（CRT）期间血清细胞因子，包括白细胞介素（IL）-1β、IL-6和肿瘤坏死因子α（TNFα）是否升高，并试图确定盆腔CRT期间发生腹泻的预后因素。
接受术后盆腔CRT的宫颈癌或子宫内膜癌患者符合本前瞻性研究的条件。在CRT期间每周对患者进行症状评估，包括腹泻和便秘。在CRT前1周、CRT期间第3周以及第5 - 6周使用免疫测定法测量血清细胞因子水平。还分析了与放疗相关的参数，如小肠的平均剂量、最小剂量和最大剂量。采用多因素逻辑回归分析评估与肠炎症状发生相关的因素。
纳入26例患者，所有患者均符合症状和剂量学参数评估条件；24例符合细胞因子水平测量条件。CRT前有腹泻和无腹泻患者的细胞因子水平无差异。CRT期间IL-6水平升高，在第5 - 6周腹泻≥2级的患者中显著高于0 - 1级患者（6.771±2.657 pg/mL对3.396±0.499 pg/mL，p = 0.046）。CRT期间血清IL-1β和TNFα水平未发生变化。多因素分析中，CRT前的腹泻和小肠最大剂量是CRT诱导腹泻的独立预后因素。
盆腔CRT期间腹泻≥2级的患者血清IL-6水平升高。CRT期间血清IL-1β和TNFα水平未发生变化。放疗相关因素和临床因素影响盆腔CRT期间腹泻的发生。
