| Objective:To evaluate the effect of TGF-β1and IL-1βexpression in serum, the cardiac function parameters, patient-related factors and Dose-Volume Histogram to the acute radiation-induced heart disease (RIHD) in patients with thoracic tumors.Method :From December 2008 to July 2010, 44 patients with lung cancer and 10 patients with esophagus cancer received three-dimensional conformal radiotherapy (3DCRT) or intensity modulated radiotherapy (IMRT). Radiation was delivered at 1.8～2.0Gy, 5 times per week to a total dose of 50～66 Gy. The target and organs at risk dose distribution were analyzed by 3-dimensiond treatment planning system. The expression of TGF-β1 and IL-1βin serum were detected by enzyme linked immunosorbent assay before and at the end of the irradiation. The cardiac injury were examed before the the radiotherapy, and within 90 days when the radiotherapy start. The acute RIHD were evaluated by Common Terminology Criteria V 3.0 (NCI-CTCAE 3.0). The effect of the expression of TGF-β1and IL-1βin serum, the cardiac function parameters , patient-related factors and Dose-Volume Histogram to the RIHD in patients with thoracic tumors were analyzed.Results :There were 38 cases of patients occured acute RIHD in the whole group. The total incidence rate was 70.4%(38/54).All of them were the grade 1, none of the grade 2 or above of acute RIHD were found. Of the acute RIHD patients ,there were 37 cases with abnormal electrocardiogram (97.4%), 3 cases with pericardial effusion (7.9%), 6 cases with cardiac troponin I (cTnI) (15.8%) and 7 cases with myocardium creatase (18.4%) higher than the normal, 7 cases with left ventricular systolic function degradation (18.4%). The expression of TGF-β1 in serum was 888.4±41.1ng/ml before the irradiation, which was higher than that of 926.1±23.1 ng/ml at the end of the radiotherapy(t=-6.479, P=0.000).The expression levels of TGF-β1 in serum in acute RIDH group was 900.6±34.5ng/ml, which was higher than that of 865.7±47.0ng/ml in normal group (t=- 2.646 ,P=0.011). The expression level of TGF-β1 before the irradiation, and the difference before and at the end of the irradiation correlated with acute RIDH (r=0.378, P=0.011 and r=0.311, P=0.040, respectively). The expression level of IL-1βin serum was 158.2±59.0ng/ml before the irradiation, and was 168.3±80.4 ng/ml at the end of the irradiation, the difference of them was not statistical significant (t=-0.771, P=0.445). The expression of IL-1βin serum before the irradiation in the acute RIHD group did not showed the statistical difference than that in the normal group (156.7±54.5ng/ml vs 150.1±61.0ng/ml, t=-0.340, P=0.735). The expression correlation of IL-1βexpression in serum before the irradiation, at the end of the irradiation and the difference between them to the acute RIHD did not showed statistical difference (P=0.735, P=0.715, and P=0.900), respectively. The expression of TGF-β1 in serum before and at the end of irradiation had positive correlation with the expression of IL-1βin serum at the end of the irradiation (r=0.4 16, P=0.0 05; r=0.3 89 ,P=0.009), respectively. The cardiac function parameters of the patients were similiar in the acute RIHD groups and in normal groups (P>0.05). The correlation between cardiac function parameters and the acute RIHD showed no statistical difference (P>0.05). None of the patient-related clinical parameters were correlated with the acute RIHD. The volumes of heart receiving irradiation of≥5Gy and≥60Gy (V5, and V60) was higher in acute RIHD group than in normal group (t=-2.173, P=0.034 and t=-3.28, P=0.002), respectively. Univariate analysis showed that the significant acute RIHD influencing factors included Dmax and V60 of the heart (P<0.05). Logistic multivariate analysis revealed that only the heart V60 was the independent influencing factor (P=0.024).Conclusion:The expression of TGF-β1 in serum is incresed after the patients with thoracic tumor receival irradiation. The expression before the irradiation and the difference before and at end of the irradiation correlate with the acute RIHD. The expression level of IL-1βin serum dose not related to RIHD. The expression level of TGF-β1 induced the expression of IL-1βin serum at the end of the irradiation. The main manifestations of the early RIHD is the abnormal electrocardiogram, which represent the conducting system of heart, the myocardial injury was uncommon. Cardiac function parameters before the irradiation are not relate to the acute RIHD. The Dmax and V60 of the heart is the main influcing factors to the acute RIHD, only V60 is the independent factor. The onset of the RIHD are concomitantly influced by the expression of TGF-β1 and part of the physical parameters receving by the heart. None of the patient-ralated and dose and volume parameters reciving by the heart correlate with the acute RIHD. |
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