DOI QR코드

DOI QR Code

Oral Glutamine Supplementation Reduces Radiotherapy-induced Esophagitis in Lung Cancer Patients

  • Gul, Kanyilmaz (Department of Radiation Oncology, Faculty of Medicine, Necmettin Erbakan University) ;
  • Muge, Akmansu (Department of Radiation Oncology, Faculty of Medicine, Gazi University) ;
  • Taner, Atasever (Department of Nuclear Medicine, Medipol Hospital) ;
  • Sehri, Elbag (Department of Pathology, Faculty of Medicine, Gazi University)
  • 발행 : 2015.02.04

초록

Background: The purpose of this study was to assess the the efficacy of oral glutamine (GLN) in prevention of acute radiation-induced esophagitis in patients with lung cancer and determine the predictive role of clinical and dosimetric parameters. Materials and Methods: Thirty-two patients diagnosed with lung cancer were studied prospectively. Sixteen patients (50%) received prophylactic powdered GLN orally in doses of 10g/8h. Patients were treated 2 Gy per fraction daily, 5 days a week. We evaluated the grading of esophagitis daily at the end of each fraction of each treatment day until a cumulative dose of 50 Gy was reached. The primary end point was radiation-induced esophagitis. Results: All patients tolerated GLN well. Toxicity grade, weight loss, serum cytokine levels and esophageal transit times exhibited statistically significant improvement in the GLN receiving group. GLN suppressed the inflammation related to the disease and treatment and reduced toxicity with statistical significance. Conclusions: This study suggests a benefical role of oral GLN use in prevention and/or delay of radiation-induced esophagitis, in terms of esophageal transit time and serum immunological parameters, as well as weight loss.

키워드

참고문헌

  1. Ahn SJ, Kahn D, Yu X, et al (2005). Dosimetric and clinical predictors for radiation-induced esophageal injury. Int J Radiat Oncol Biol Phys, 61, 335-47. https://doi.org/10.1016/j.ijrobp.2004.06.014
  2. Antonadou D, Coliarakis N, Synodinou M, et al (2001). Randomized phase III trial of radiation treatment$\pm$amifostine in patients with advanced stage lung cancer. Int J Radiat Oncol Biol Phys, 51, 915-22. https://doi.org/10.1016/S0360-3016(01)01713-8
  3. Amebo, AA Adjei, EK Harrison, et al (1997). Prophylactic effect of dietary GLN supplementation on interleukin 8 and tumour necrosis factor alpha production in trinitrobenzene sulphonic acid induced colitis. Gut, 41, 487-93. https://doi.org/10.1136/gut.41.4.487
  4. Bradley J (2005). A review of radiation dose escalation trials for non-small cell lung cancer within the Radiation Therapy Oncology Group. Semin Oncol, 32, 111-3. https://doi.org/10.1053/j.seminoncol.2005.03.020
  5. Belderbos J, Heemsbergen W, Hoogeman M, et al (2005). Acute esophageal toxicity in non-small cell lung cancer patients after high dose conformal radiotherapy. Radiother Oncol, 75, 157-64. https://doi.org/10.1016/j.radonc.2005.03.021
  6. Chattopadhyay S, Saha A, Azam M, et al (2014). Role of oral glutamine in alleviation and prevention of radiation-induced oral mucositis: A prospective randomized study. South Asian J Cancer, 3, 8-12. https://doi.org/10.4103/2278-330X.126501
  7. Choy H, Akerley W, Safran H, et al (1998). Multiinstitutional phase II trial of paclitaxel, carboplatin, and concurrent radiation therapy for locally advanced non-small cell lung cancer. J Clin Oncol, 16, 3316-22.
  8. Topkan E, Yavuz MN, Onal C, et al (2009). Prevention of acute radiation-induced esophagitis with GLN in non-small cell lung cancer patients treated with radiotherapy: Evaluation of clinical and dosimetric parameters, Lung Cancer, 63, 393-9. https://doi.org/10.1016/j.lungcan.2008.06.015
  9. Etiz D, Bayman E, Akcay M, et al (2013). Dosimetric and clinical predictors of acute esophagitis in lung cancer patients in turkey treated with radiotherapy. Asian Pac J Cancer Prev, 14, 4223-8. https://doi.org/10.7314/APJCP.2013.14.7.4223
  10. Huang EY, Wan Leung S, Wang CJ, et al (2000). Oral GLN to alleviate radiation-induced oral mucositis: A pilot randomized trial. Int J Radiat Oncol Biol Phys, 46, 535-9. https://doi.org/10.1016/S0360-3016(99)00402-2
  11. Iascone C, Di Giulio E, Maffi C, et al (2004). Use of radioisotopic esophageal transit in the assessment of patients with symptoms of reflux and non-specific esophageal motor disorders. Dis Esophagus, 17, 218-22. https://doi.org/10.1111/j.1442-2050.2004.00411.x
  12. Jiang N, Zhao JZ, Chen XC, et al (2014). Clinical determinants of weght loss in patients with esophageal carcinoma during radiotherapy: a prospective longitudinal view. Asian Pac J Cancer Prev, 15, 1943-8. https://doi.org/10.7314/APJCP.2014.15.5.1943
  13. Rose J, Rodrigues G, Yaremko B, et al (2009). Systematic review of dose-volume parameters in the prediction of esophagitis in thoracic radiotherapy. Radiother Oncol, 91, 282-7. https://doi.org/10.1016/j.radonc.2008.09.010
  14. Kuhn KS, Muscaritoli M, Wischmeyer P, et al (2010). GLN as indispensable nutrient in oncology: experimental and clinical evidence. Eur J Nutr, 49, 197-210. https://doi.org/10.1007/s00394-009-0082-2
  15. Plata-Salaman CR, Oomura Y, Kai Y (1998). Tumor necrosis factor and interleukin 1 Beta: suppression of flood intake by direct action in the central nervous system. Brain Res, 448, 106-14.
  16. Rodriguez N, Algara M, Fora P, et al (2009). Predictors of acute esophagitis in lung cancer patients treated with concurent three-dimensional conformal radiotherapy and chemotherapy. Int J Radiat Oncol Biol Phys, 73, 810-7. https://doi.org/10.1016/j.ijrobp.2008.04.064
  17. Sasso G, Rambaldi P, Sasso FS et al (2008). Scintigraphic evaluation of esophageal transit during radiotherapy to the mediastinum. BMC Gastroenterology, 8, 51. https://doi.org/10.1186/1471-230X-8-51
  18. Shih A, Miaskowski C, Dodd M, et al (2003). Mechanisms for radiation-induced oral mucositis and the consequences. Cancer Nursing, 26, 222-9. https://doi.org/10.1097/00002820-200306000-00008
  19. Singh AK, Lockett MA, Bradley JD (2003). Predictors of radiation-induced esophageal toxicity in patients with nonsmall-cell lung cancer treated with three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys, 55, 337-41. https://doi.org/10.1016/S0360-3016(02)03937-8
  20. Song XY, Zhou SJ, Xiao N, et al (2013). Research on the relationship between serum levels of inflammatory cytokines and non-small cell lung cancer. Asian Pac J Cancer Prev, 14, 4765-8. https://doi.org/10.7314/APJCP.2013.14.8.4765
  21. Stanley KE (1980). Prognostic factors for survival in patients with inoperable lung cancer. J Natl Cancer Inst, 65, 25-32.
  22. Tutanc OD, Aydogan A, Akkucuk S, et al (2013). The efficacy of oral glutamine in prevention of acute radiotherapy-induced esophagitis in patients with lung cancer. Contemp Oncol (Pozn), 17, 520-4.
  23. Turkolmez S, Atasever T, Akmansu M (2005). Effects of radiation therapy on esophageal transit in patients with inner quadrant breast tumour. Nucl Med Commun, 26, 721-6. https://doi.org/10.1097/01.mnm.0000171785.03403.6f
  24. Wermer- Wasik M, Scott C, Movsas B, et al (2003). Amifostine as mucosal protectant in patients with locally advanced non-small cell lung cancer (NSCLC) receiving intensive chemotherapy and thoracic radiotherapy (RT): results of the radiation therapy oncology group (RTOG) 98-01 study. Int J Radiat Oncol Biol Phys, 57, 216. https://doi.org/10.1016/S0360-3016(03)01029-0

피인용 문헌

  1. Oral Glutamine in Preventing Treatment-Related Mucositis in Adult Patients With Cancer vol.31, pp.2, 2016, https://doi.org/10.1177/0884533615611857
  2. Protection against Radiotherapy-Induced Toxicity vol.5, pp.3, 2016, https://doi.org/10.3390/antiox5030022
  3. Adjunctive Treatments for the Prevention of Chemotherapy- and Radiotherapy-Induced Mucositis pp.1552-695X, 2018, https://doi.org/10.1177/1534735418794885
  4. Oral glutamine supplements reduce concurrent chemoradiotherapy-induced esophagitis in patients with advanced non-small cell lung cancer vol.98, pp.8, 2019, https://doi.org/10.1097/MD.0000000000014463