Study On The Correlation Between Acute Radiation-induced Oral Mucositis And Cell Factor

Objectives:1. Explore the degree of acute radiation oral mucosa and KPS score in patients with nasopharyngeal carcinoma at early ,middle and late stage of radiotherapy.2. Explore the level of inflammatory cytokines IFN-y, TNF-a, IL-2, IL-4, IL-6, IL-10,EGF in the saliva of patients with nasopharyngeal carcinoma at early, middle and late stage of radiotherapy,compare the level of cytokines in the saliva and blood,assess the role of saliva in the prognosis of the acute radiation oral mucosa inflammation.3. Explore the level of T cell subset CD4+/CD8+, NK in the saliva of patients with nasopharyngeal carcinoma at early, middle and late stage of radiotherapy.4. Explore the correlation between radiation and acute radiation oral mucosa inflammation, the correlation between acute radiation oral mucosa inflammation and cytokines, T cell subset, and EGF. Provide scientific evidences for the research of the the role of saliva in the prognosis of the acute radiation oral mucosa inflammation and improvement of clinical efficiency of acute radiation oral mucosa inflammation.Methods:44 patients (4 dropped out) who underwent radiotherapy for the first time with nasopharyngeal carcinoma (According to the TNM staging, M staging is MO) in the Tumor Hospital of Yunnan Province were enrolled in the study. The diagnosis of all patients was confirmed by pathology. Explore the degree of acute radiation oral mucosa, KPS score, cytokines, T cell subset, and EGF in patients at early,middle and late stage of radiotherapy. Explore the the correlation between acute radiation oral mucosa inflammation and cytokines, T cell subset, and EGF. Measurement datas were expressed as mean±standard deviation ( x±s),and single factor analysis of variance(ONE WAY ANOVA) , t test and LSD-t test were used to get the statistical significance,enumeration data were expressed as n(%),χ2 test were used to get the statistical significance. P < 0.05 was considered to be statistically significant.Results:1. At the fourth week of radiotherapy, there were 4 (9.09%) and 14 (31.82%) patients reach Ⅰ° and Ⅱ° acute radiation oral mucosa inflammation respectively,there were 23(52,27%) and 3 (6.82%) patients reach Ⅲ°and Ⅳ°acute radiation oral mucosa inflammation respectively; the KPS score of 31 (70.45%) patients reduced and 13(29.55%) remained the same. After radiotherapy, there were 0 (0%) and 4 (9.09%)patients reach Ⅰ °and Ⅱ °acute radiation oral mucosa inflammation respectively, there were 15 (34.09%) and 25 (56.82%) patients reach Ⅲ°and Ⅳ°acute radiation oral mucosa inflammation respectively. So with the increasing of radiation dose, the incidence of acute radiation oral mucosa inflammation increased,so was the incidence of severe acute radiation oral mucosa inflammation(Ⅲ°and Ⅳ°); the KPS score of 39(88.64%) patients reduced and 5 (11.36%) remained the samethe difference was statistically significant (P<0.01).2. The level of IFN-γ, TNF-α, IL-2, IL-4, IL-6 and IL-10 at the fourth week of radiotherapy were increased compared with that at before radiotherapy (P<0.01).After radiotherapy, the level of IL-10 continue to increase (P<0.01), the level of IFN-γ, TNF-α, IL-2, IL-4 and IL-6 was lower than that before radiotherapy (P<0.01).The level of cytokines in saliva were higher than that in the blood at the same time of radiotherapy (P<0.01).3. The level of EGF in saliva at the fourth week of radiotherapy was decreased compared with that before radiotherapy (P<0.01). After radiotherapy, the level of EGF in saliva continue to decrease, the difference was statistically significant (P<0.01), The level of EGF in saliva were lower than that in the blood at the same time of radiotherapy (P<0.01).4. With the increasing of radiation dose, the level of CD4+/CD8+and NK decreased, the difference was statistically significant (P<0.01).Conclusions:1. With the increasing of radiation dose, the incidence of acute radiation oral mucosa inflammation increased, radiation accumulation increased the severity of acute radiation oral mucosa inflammation and decreased patients’quality of life.2. The change of cytokines in blood and saliva were similar after radiation. Cytokines play an important role in the occurrence and development of acute radiation oral mucosa inflammation, suggest that saliva may play an important role in the prognosis of the acute radiation oral mucosa inflammation.3. Radiation may destroy the patients’ immune function.4. With the increasing of radiation dose, the level of EGF decreased, speculating that EGF may be involved in the development of radioactive stomatitis and healing.5. Research of the changes of cytocines in the saliva of acute radiation oral mucosa inflammation and cytokines may provide scientific evidences for the research of the the role of saliva in the prognosis of the acute radiation oral mucosa inflammation .