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Original Research

Open Access

Clinical analysis of predisposing factors for radiation enteritis in patients with cervical cancer

  • Jing Fang1
  • Jinmei Fang1
  • Ailin Wu1
  • Yufei Zhao1,*,
  • Yun Liu1,*,

1Department of Radiation Oncology, Anhui Provincial Cancer Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 230031 Hefei, Anhui, China

DOI: 10.31083/j.ejgo4205143 Vol.42,Issue 5,October 2021 pp.951-956

Submitted: 20 July 2021 Accepted: 25 August 2021

Published: 15 October 2021

*Corresponding Author(s): Yufei Zhao E-mail: zhaoyufei@ustc.edu.cn

Abstract

Objective: Radiation enteritis (RE) is one of the most common radiation-induced toxicities in patients with cervical cancer undergoing pelvic radiotherapy. This study aimed to evaluate predisposing factors for RE in patients with cervical cancer. Methods: In total, 414 patients with cervical cancer undergoing radiotherapy were retrospectively enrolled from Anhui Provincial Cancer Hospital. We col-lected data on age; body mass index; International Federation of Gynecology and Obstetrics stage (I–IV); histology; fasting blood glucose levels; chemotherapy regimen; radiation dose; and histories of hypertension, diabetes mellitus, and surgery. Univariate and multivariate Cox regression analyses were used to assess possible predisposing factors for RE. Results: Incidences of acute RE (ARE) and chronic RE (CRE) were 65.2% and 13.1%, respectively. No prior surgery, radi-ation dose ≥56 Gy, hypertension, and hyperglycemia were found to be independent risk factors for ARE (95% confidence interval [CI], p< 0.05). Hypertension, diabetes mellitus, and hyperglycemia were independent risk factors for CRE (95% CI, p≤ 0.01). Significantly higher incidences of ARE (90.6% vs. 75.8%, p < 0.001) and CRE (62.5% vs. 21.2%, p = 0.001) were found in patients with diabetes mellitus and poor glucose control. Conclusions: To reduce the occurrence of RE in patients with cervical cancer, comorbidities such as diabetes mellitus, hyperglycemia, and hypertension should be controlled, along with consideration of treatment-related factors such as the radio-therapy method and total radiation dose.


Keywords

Cervical cancer; Comorbidity; Predisposing factors; Radiation enteritis; Radio-therapy


Cite and Share

Jing Fang,Jinmei Fang,Ailin Wu,Yufei Zhao,Yun Liu. Clinical analysis of predisposing factors for radiation enteritis in patients with cervical cancer. European Journal of Gynaecological Oncology. 2021. 42(5);951-956.

References

[1] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians. 2021; 71: 209–249.

[2] Lu L, Li W, Chen L, Su Q, Wang Y, Guo Z, et al. Radiation-induced intestinal damage: latest molecular and clinical developments. Future Oncology. 2019; 15: 4105–4118.

[3] Loge L, Florescu C, Alves A, Menahem B. Radiation enteritis: Diagnostic and therapeutic issues. Journal of Visceral Surgery. 2020; 157: 475–485.

[4] Heijkoop ST, Westerveld H, Bijker N, Feije R, Sharfo AW, van Wieringen N, et al. Optimal Patient Positioning (Prone Versus Supine) for VMAT in Gynecologic Cancer: a Dosimetric Study on the Effect of Different Margins. International Journal of Radiation Oncology*Biology*Physics. 2016; 96: 432–439.

[5] Portelance L, Chao KSC, Grigsby PW, Bennet H, Low D. Intensity-modulated radiation therapy (IMRT) reduces small bowel, rectum, and bladder doses in patients with cervical cancer receiving pelvic and para-aortic irradiation. International Journal of Radiation Oncology*Biology*Physics. 2001; 51: 261–266.

[6] Citrin D, Cotrim AP, Hyodo F, Baum BJ, Krishna MC, Mitchell JB. Radioprotectors and Mitigators of Radiation‐Induced Normal Tissue Injury. The Oncologist. 2010; 15: 360–371.

[7] Pfaendler KS, Wenzel L, Mechanic MB, Penner KR. Cervical Cancer Survivorship: Long-term Quality of Life and Social Support. Clinical Therapeutics. 2015; 37: 39–48.

[8] Zheng Y, Gao W, Spratt DE, Sun Y, Xing L. Management of gastrointestinal perforation related to radiation. International Journal of Clinical Oncology. 2020; 25: 1010–1015.

[9] Lawton C. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer. Yearbook of Oncology. 2011; 2012: 125–126.

[10] Small W, Mell LK, Anderson P, Creutzberg C, De Los Santos J, Gaffney D, et al. Consensus Guidelines for Delineation of Clinical Target Volume for Intensity-Modulated Pelvic Radiotherapy in Postoperative Treatment of Endometrial and Cervical Cancer. International Journal of Radiation Oncology*Biology*Physics. 2008; 71: 428–434.

[11] Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European organization for research and treatment of cancer (EORTC). International Journal of Radiation Oncology*Biology*Physics. 1995; 31: 1341–1346.

[12] Roszak A, Wareńczak-Florczak Z, Bratos K, Milecki P. Incidence of radiation toxicity in cervical cancer and endometrial cancer patients treated with radiotherapy alone versus adjuvant radio-therapy. Reports of Practical Oncology & Radiotherapy. 2012; 17: 332–338.

[13] MacNaughton WK. Review article: new insights into the pathogenesis of radiation-induced intestinal dysfunction. Alimentary Pharmacology and Therapeutics. 2000; 14: 523-528.

[14] Qu W, Zhang L, Ao J. Radiotherapy Induces Intestinal Barrier Dysfunction by Inhibiting Autophagy. ACS Omega. 2020; 5: 12955–12963.

[15] Liu J, Liu C, Yue J. Radiotherapy and the gut microbiome: facts and fiction. Radiation Oncology. 2021; 16: 9.

[16] Nguyen NP, Antoine JE, Dutta S, Karlsson U, Sallah S. Current concepts in radiation enteritis and implications for future clinical trials. Cancer. 2002; 95: 1151–1163.

[17] Gerassy-Vainberg S, Blatt A, Danin-Poleg Y, Gershovich K, Sabo E, Nevelsky A, et al. Radiation induces proinflammatory dysbio-sis: transmission of inflammatory susceptibility by host cytokine induction. Gut. 2018; 67: 97–107.

[18] Chen M, Tseng C, Tseng C, Kuo Y, Yu C, Chen W. Clinical Out-come in Posthysterectomy Cervical Cancer Patients Treated with Concurrent Cisplatin and Intensity-Modulated Pelvic Radiother-apy: Comparison with Conventional Radiotherapy. International Journal of Radiation Oncology*Biology*Physics. 2007; 67: 1438–1444.

[19] Shadad AK. Gastrointestinal radiation injury: Symptoms, risk factors and mechanisms. World Journal of Gastroenterology. 2013; 19: 185.

[20] Kavanagh BD, Pan CC, Dawson LA, Das SK, Li XA, Ten Haken RK, et al. Radiation Dose–Volume Effects in the Stomach and Small Bowel. International Journal of Radiation Oncology*Biology*Physics. 2010; 76: S101–S107.

[21] Li Q, Chen J, Zhu B, Jiang M, Liu W, Lu E, et al. Dose Volume Effect of Acute Diarrhea in Post-Operative Radiation for Gynecologic Cancer. Revista de Investigación Clínica. 2017; 69: 329–335.

[22] Chen Z, Zhu L, Zhang B, Meng M, Yuan Z, Wang P. Dose-volume histogram predictors of chronic gastrointestinal complications after radical hysterectomy and postoperative intensity modulated radiotherapy for early-stage cervical cancer. BMC Cancer. 2014; 14: 789.

[23] Kasibhatla M, Clough RW, Montana GS, Oleson JR, Light K, Stef-fey BA, et al. Predictors of severe gastrointestinal toxicity after external beam radiotherapy and interstitial brachytherapy for advanced or recurrent gynecologic malignancies. International Journal of Radiation Oncology*Biology*Physics. 2006; 65: 398–403.

[24] Huang E, Sung C, Ko S, Wang C, Yang KD. The Different Volume Effects of Small-Bowel Toxicity during Pelvic Irradiation between Gynecologic Patients with and without Abdominal Surgery: a Prospective Study with Computed Tomography-Based Dosimetry. International Journal of Radiation Oncology*Biology*Physics. 2007; 69: 732–739.

[25] Li J, Ning N, Rao Q, Chen R, Wang L, Lin Z. Pretreatment glycemic control status is an independent prognostic factor for cervical cancer patients receiving neoadjuvant chemotherapy for locally advanced disease. BMC Cancer. 2017; 17: 517.

[26] Li J, Wu MF, Lu HW, Zhang BZ, Wang LJ, Lin ZQ. Impact of Hyperglycemia on Outcomes among Patients Receiving Neoadjuvant Chemotherapy for Bulky Early Stage Cervical Cancer. PLoS ONE. 2016; 11: e0166612.

[27] Alashkham A, Paterson C, Hubbard S, Nabi G. What is the impact of diabetes mellitus on radiation induced acute proctitis after radical radiotherapy for adenocarcinoma prostate? a prospective longitudinal study. Clinical and Translational Radiation Oncology. 2019; 14: 59–63.

[28] Matsumoto N, Omagari D, Ushikoshi-Nakayama R, Yamazaki T, Inoue H, Saito I. Hyperglycemia Induces Generation of Reactive Oxygen Species and Accelerates Apoptotic Cell Death in Salivary Gland Cells. Pathobiology. 2021; 88: 234–241.

[29] Ozyel B, Le Gall G, Needs PW, Kroon PA. Anti‐Inflammatory Effects of Quercetin on High‐Glucose and Pro‐Inflammatory Cytokine Challenged Vascular Endothelial Cell Metabolism. Molec-ular Nutrition & Food Research. 2021; 65: e2000777.

[30] Eifel PJ, Jhingran A, Bodurka DC, Levenback C, Thames H. Cor-relation of Smoking History and other Patient Characteristics with Major Complications of Pelvic Radiation Therapy for Cervical Cancer. Journal of Clinical Oncology. 2002; 20: 3651–3657.

[31] Barnett GC, De Meerleer G, Gulliford SL, Sydes MR, Elliott RM, Dearnaley DP. The Impact of Clinical Factors on the Development of Late Radiation Toxicity: Results from the Medical Research Council RT01 Trial (ISRCTN47772397). Clinical Oncology. 2011; 23: 613–624.


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