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Influencing Factors to the Acute Radiation-Induced Heart Disease in Patients with Thoracic Tumor

Author: WangXiao
Tutor: WangJun；HanChun
School: Hebei Medical University
Course: Oncology
Keywords: Three-dimensional conformal radiation therapy IMRT Radioactive heart damage Transforming growth factor-β1 Interleukin -1β Dose volume histograms
CLC: R818
Type: Master's thesis
Year: 2011
Downloads: 60
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Abstract

Objective: To study the chest tumor radiation therapy serum cytokine TGF-β1, IL-1β expression levels, basic cardiac functional status and clinical physical factors radioactive acute cardiac injury occurred. Methods: December 2008 to July 2010, collected in our department accepted conformal or intensity modulated radiation therapy in patients with chest tumor 54 cases including 44 cases of patients with lung cancer, 10 cases of patients with esophageal cancer. The radiation dose was 1.8 ~ 2.0Gy / times / day, 5 days / week, PTV receiving prescription dose of 50 ~ 66Gy, application of three-dimensional treatment planning system analysis target dose distribution and dose OARs. Patients before radiotherapy and fasting mining after the end of radiotherapy cubital vein and application of enzyme-linked immunosorbent assay in serum expression levels of TGF-β1, IL-1β, and before radiotherapy, radiation treatment began 90 days were detected in patients with heart damage The status application NCI-CTCAE 3.0 evaluation of acute radiation-induced cardiac injury grading standards. Analysis of serum cytokine TGF-β1, IL-1β expression levels, the impact the underlying cardiac functional status and related clinical physical factors, such as radioactive heart damage. Results: (1) All patients 38 cases of acute radiation-induced heart injury occurs, the total incidence rate of 70.4% (38/54), are a radioactive heart damage, not two and two acute radiation-induced heart injury occurs. 38 cases of acute radiation in patients with heart damage, abnormal electrocardiogram 37 cases (97.4%), pericardial effusion in 3 cases (7.9%), troponin I elevation in 6 cases (15.8%), cardiac enzymes increased in 7 patients (18.4% reduced), left ventricular systolic function (EF, SF) 7 (18.4%). (2) radiation therapy, the serum level of TGF-β1 expression was 888.4 ± 41.1ng/ml, the end of radiotherapy, the expression level of 926.1 ± 23.1 ng / ml, the end of radiotherapy, elevated level of serum TGF-β1 expression (t = -6.479 P = 0.000); occurred after radiotherapy in patients with acute radiation-induced cardiac injury serum TGF-β1 basal expression level was 900.6 ± 34.5ng/ml, in no acute radiation-induced cardiac damage in patients of 865.7 ± 47.0ng/ml of (t = -2.646, P = 0.011). Spearman correlation analysis showed that TGF-β1 radiotherapy baseline levels (r = 0.378, P = 0.011), before and after radiotherapy difference (r = 0.311, P = 0.040) associated with acute radiation-induced heart damage. (3) radiation therapy before serum IL-1β expression levels of 158.2 ± 59.0ng/ml, the end of radiotherapy, the expression level of 168.3 ± 80.4 ng / ml serum IL-1β expression before and after radiotherapy was no significant difference (t = -0.771 , P = 0.445); occurrence of acute radiation-induced cardiac damage in patients with serum IL-1β basis of the expression level after radiotherapy 156.7 ± 54.5ng/ml-acute radiation-induced heart damage in patients with basal expression level did not occur to 150.1 ± 61.0ng/ml nor statistics learning differences (t = -0.340, P = 0.735). Before radiotherapy basal levels of IL-1β (P = 0.735), after radiotherapy expression levels (P = 0.715), before and after radiotherapy difference (P = 0.900), with no acute radiation-induced cardiac injury. (4) before radiotherapy, after the expression levels of TGF-β1 expression levels of IL-1β after radiotherapy showed a positive correlation (r = 0.416, P = 0.005; r = 0.389, P = 0.009). (5) the occurrence of acute radiation-induced cardiac damage in patients with acute radiation did not occur in patients with heart damage before radiotherapy in patients with underlying heart function indicators t test showed no significant difference. Spearman correlation analysis showed underlying cardiac functional status and acute radiation-induced heart damage occurred without significantly related (P gt; 0.05). (6) clinical, physical factors and acute and late radiation-induced lung injury: occurrence of acute radiation-induced cardiac damage in patients with heart V ₅, V ₆₀ acute radiation higher than those without heart damage patients (t = -2.173, P = 0.034; t = -3.28, P = 0.002). Univariate analysis showed the heart D _max, V ₆₀ is a factor in the radioactive heart damage occurred (P = 0.043, P = 0.024) (P lt; 0.05). Logistic regression analysis showed that heart V ₆₀ (P = 0.024) of acute radiation-induced heart injury occurs independent. Conclusion: (1) TGF-β1 expression levels, before radiotherapy basal expression levels, and the difference before and after radiotherapy associated with acute radiation-induced heart damage after radiotherapy. IL-1β expression levels of radioactive heart damage no correlation. Before and after radiotherapy, high expression of TGF-β1-induced IL-1β expression levels after radiotherapy. (2) early the radioactive heart damage to the cardiac conduction system damage (abnormal ECG) is the most common, rare myocardial injury. (3) the patient's underlying cardiac function in patients with acute radioactive heart damage occurred no significant correlation. (4) found no clinical factors and acute heart damage. Heart D _max, V ₆₀ main physical factors associated with acute radiation-induced heart damage. V ₆₀ (P = 0.024), independent factors affect the acute radiation-induced heart injury. (5) chest tumor radiation therapy, radioactive cardiac injury incidence, but the occurrence of the degree is not serious, occurred by the combined effects of the cytokine expression levels, and some of the physical factors.

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