Curative Effect Observation Of Pevention And Treatment For Acute Radiation Esophagitis By Huisheng Koufuye

Background:Radiation therapy has become one of three primary means of treatment of malignant tumors, keeping pace with surgical treatment and chemotherapy. Radiation therapy can kill tumor cells to the maximum extent and protect normal organs and tissues through fractionated radiotherapy by virtue of differences in effects and damages of ionizing radiation on malignant tumor cells (groups) and normal cells (groups) of human organs and tissues, and differences in the ability of repairing different injured cells (groups). Radiation therapy is widely used in the comprehensive treatment of chest malignant tumors (such as lung cancer, esophageal cancer and thymoma) as a primary treatment with exact effect. However, the esophagus is often inescapable to appear in the radiation field out of the thoracic neoplasms. Esophageal mucosa is relatively sensitive to ionizing radiation, so that radioactive substances can cause epithelial hyperemia, edema and concurrent infections on the normal esophagus in the radiation field. On this basis, esophageal muscle and nerve damages weaken esophageal peristalsis and then aggravate the damages. These radiotherapy-induced side effects occurred within90days after radiology radiotherapy were called acute radiation esophagitis (ARE). Patients are manifested as substernal burning sensation, odynophagia, acid reflux, which are progressively increased. They can impact on patient’s normal diet and reduce the quality of life, or even interrupt the treatment process and limit the curative effect of radiotherapy. Thus, acute radiation esophagitis is a dose-limiting toxic and side effect of radiation therapy of chest malignant tumor. For this reason, the prevention and treatment of its occurrence and development are essential for guaranteeing the smooth implementation of radiotherapy, improving local tumor control rate and reducing normal tissue damages. There have been some related research reports about acute radiation esophagitis at home and abroad. However, there is still not a uniform treatment guideline for clinical work. In general, symptomatic and supportive therapies are used such as corticosteroids, vitamins, antibiotics and local anesthetics. Although these therapies can relieve symptoms, they cannot reduce the incidence of the disease, with significant drug-related toxic and side effects. In recent years, TCM has become a new choice for prevention and treatment of radiation injuries including radiation esophagitis. A large number of modern pharmacological studies have shown that Huisheng Koufuye can inhibit tumor cell proliferation, enhance human immune function and protect bone marrow cells, and play a sensitizing role during chemotherapy, thus improving patient’s quality of life and the comprehensive efficacy. Therefore, this clinical study intends to evaluate the effect of Huisheng Koufuye on prevention and treatment of acute radiation esophagitis induced by radiotherapy of chest malignant tumors, providing a new choice for clinical work.Objective:Huisheng Koufuye is an adjuvant therapy medication for malignant tumors, with pleiotropic effects and fewer toxic and side effects. It can improve local blood supply, increase cell oxygenation and accelerate free radical scavenging due to the effects of promoting circulation and removing stasis. In addition, it can also improve the body’s resistance to injury and enhance the ability to repair injured tissue due to its effect of immunological enhancement. Hence, this study intends to evaluate the effects of Huisheng Koufuye on prevention and treatment of acute radiation esophagitis.Methods:86cases of patients diagnosed as lung cancer, esophageal cancer and thymoma in need of radiation therapy were randomly divided into the treatment group(n=43) and the control group(n=43). The treatment group was given Huisheng Koufuye since seven days before radiotherapy. The control group was given Homemade compound procaine pain killing mixture after the occurrence of radiation esophagitis. The treatment time was recorded since the occurrence of clinical symptom (radiation esophagitis) in enrolled patients and the use of drugs. With seven days as a cycle, the observed course of treatment included four cycles. Referring to the toxicity grading criteria by United States Radiation Therapy Oncology Group (RTOG), the completion rates of radiation therapy, the incidence rates of acute radiation esophagitis, the occurrence times, the degree of ease, complications and toxic and adverse effects during radiotherapy were compared between two groups.Results:The completion rate of radiation therapy was100%in the treatment group and86.05%in the control group(P<0.05). The occurrence time of acute radiation esophagitis was (18.9±0.5) d after radiotherapy in the treatment group and significantly delayed compared with the control group (13.1±0.7) d (P<0.05); the incidence rates were79.07%and95.35%, respectively (P<0.05); the total effective rates were93.02%and76.74%, respectively (P<0.05). In addition, four cases were forced to interrupt treatment in the control group due to serious complications.Conclusion:Huisheng Koufuye can effectively postpone the occurrence time of acute radiation esophagitis, significantly reduce the incidence, delay the disease progression, improve patient’s compliance, guarantee the smooth progress of radiotherapy, and improve the short-term effect.