A Clinical Study On The Damage To The Heart Caused By Different Total Radiation In Radiotherapy Of Esophageal Cancer

Objective:To compare the serum myocardial enzyme spectrum,electrocardiogram,BNP,Troponin and LVEF before radiotherapy and in the treatment dose with 40 Gy,50Gy and60 Gy in the middle and lower segment esophagus cancer patients.To explore serum enzymes,LVEF,BNP,Troponin and ECG monitoring of cardiac injury in clinical applications in three-dimensional conformal radiotherapy of esophageal cancer,and to explore the correlation among the control of esophageal cancer therapeutic dose cause early heart damage.Methods:Thirty two patients were accepted for the first time in our department for three-dimensional conformal radiotherapy for the middle and lower segment esophagus cancer during the period 2015 to 2017.Screening conditions: patients aged ≤ 70 years;confirmed by pathology and clinical imaging diagnosis of lower thoracic esophageal cancer patients;initial radiotherapy;no previous history of heart disease,blood pressure control is good,no significant ECG abnormalities,myocardial enzymes detected in Normal range;echocardiographic measurements showed left ventricular ejection fraction(LVEF)≥60%.Radiotherapy simulator machine were used for body membrane production,CT scans positioned transmitting image data to the TPS on the three-dimensional conformal radiotherapy planning,based on a reasonable choice of the patient’s body fat with 6MV linear accelerator energy X-ray irradiation,the prescribed dose was suggested higher than 60 Gy in the tumor,a single dose of 1.8-2Gy / f,5f / w,the treatment time of5.5-6 weeks.all patients were check serum enzymes,LVEF,BNP,Troponin and ECG in the period before radiotherapy and when radiation dose to 40 Gy,50Gy and 60 Gy.3,before radiotherapy,radiotherapy 40 GY,radiotherapy 50 GY,radiotherapy 60 GY,the patients were conducted to respond to various indicators of heart function,such as myocardial enzymes,troponin,dynamic electrocardiogram,echocardiography.4,to statistics and analysis of the resulting data,choose SPSS 17.0 data collection and analysis,measurement data use the average(X)± standard deviation(S)to describe the experimental results of the data,the comparison between the two groups uses T test,The comparison between the two groups of counting data uses the card square test,with α =0.05 as the test level,and P 0.05 as the difference is considered to be statistically significant.To investigate the relationship between radiation dose increase and radiation heart injury in esophageal cancer radiotherapy,and to guide the implementation of radiotherapy program based on the experimental results.Results:1.With the increase of the dose of exposure to esophageal cancer,the average dose of exposure to the heart and the highest dose of exposure to the heart have gradually increased,while the volume of exposure to the heart V30,V40,and V50 has gradually increased.2.No abnormal electrocardiogram changes were observed in all subjects during radiotherapy to 40 Gy.A case of T-wave inversion occurred in all the subjects studied during radiotherapy at 50 Gy.In radiotherapy to 60 Gy,one case of early chamber and one case of early chamber were added to the study subjects.The abnormal performance of dynamic electrocardiogram is mainly T wave changes and arrhythmias,which is related to radiation-induced capillary endothelium damage and heart conduction system damage.3.The abnormal rate of LVEF at 40 Gy radiotherapy was 3.12 %;The abnormal rate of LVEF at 50 Gy radiotherapy was 6.25 %;The abnormal rate of LVEF at 60 Gy radiotherapy was 9.68 %;With the increase of the dose of heart irradiation,the abnormal rate of LVEF gradually increased,and the difference was statistically significant(P 0.05).Its abnormal consideration is related to radiation-induced cardiac contraction and diastolic dysfunction,but when the heart has radioactive damage,it will appear as an anomaly of LVEF.4.There was no significant difference in the level of cardiac enzymes spectrum between the four groups before radiotherapy,40 Gy radiotherapy,50 Gy radiotherapy,and60 Gy radiotherapy.There was no statistical difference in the level of cardiac enzymes spectrum.(P> 0.05).The analysis may be due to heart damage that does not reach the high level of cardiac enzyme expression,or due to the timeliness of this indicator.5.The level of myocalcin in four groups before radiotherapy,40 Gy in radiotherapy,50 Gy in radiotherapy,and 60 Gy in radiotherapy were measured.The comparison between the two groups of four groups showed that the level of myocalcin did not change significantly,and there was no statistical difference(P> 0.05).6.The four groups of BNP were detected before radiotherapy,40 Gy radiotherapy,50 Gy radiotherapy,and 60 Gy radiotherapy.The comparison between the two groups of four groups showed an increased trend,but the difference was not statistically significant(P > 0.05).When continuing to observe 3 months and 6 months after radiotherapy,the value of BNP continued to increase,which was statistically different from that before radiotherapy.BNP values are positively correlated with the degree of heart failure,and their values can be used as an indicator to assess the degree of heart failure and prognosis of patients.7.Among all the subjects in the study,there were no adverse manifestations such as aortic valve reflux,pericardial effusion,and myocardial segmental dysactivity before radiotherapy,radiotherapy 40 Gy,and radiotherapy 50 Gy.However,there were 5 cases ofmoderate and severe aortic valve reflux during radiotherapy to 60 Gy.There were 3 cases of pericardial effusion in 1 month after the end of radiotherapy,2 cases of myocardial segmental dysactivity in 2 months after the end of radiotherapy,and there was a gradual increase in the dose of radiotherapy in the left ventricle.It can be seen that when the heart has a radioactive heart injury,its performance in the ultrasonic electrocardiogram is varied,and it will appear differently with the process of heart failure.Conclusion:1.In the course of radiotherapy of esophageal cancer,the dose of the irradiated heart and the irradiated volume increase with the increase in the dose of esophageal cancer radiotherapy.Therefore,in esophageal cancer radiotherapy,we can evaluate the dose of the heart in time through dose volume distribution and control it within the dose volume range of the heart tolerance to achieve the purpose of reducing the incidence of radioactive heart damage.2.The abnormal rate of ECG and ejection fraction increased with the increase of cardiac receptor,but the changes of cardiac enzymes and troponin were not significant.The analysis may be related to the single dose of exposure to the heart.When the heart is exposed to a single dose of large doses,there will be a significant increase in myocardial enzymes and troponin,and in the three-dimensional conformal radiotherapy under conventional dose management.The changes of cardiac enzymes and troponin in patients with heart radiation injury were not obvious.Therefore,in the three-dimensional conformal radiotherapy of esophageal cancer under conventional dose division,cardiomyase and myocardial protein are not as sensitive as dynamic electrocardiogram and echocardiogram to the prediction of radioactive heart damage.The abnormal manifestations of dynamic electrocardiogram are mainly T-wave changes and arrhythmias,which are related to radiation-induced capillary endothelium damage and heart conduction system damage,which can reflect the occurrence of radioactive heart damage earlier.In clinical work,there is an important prediction value for the occurrence of radioactive heart damage.3.In esophageal cancer radiotherapy,patients with abnormal electrocardiogram and ejection fraction earlier had significant changes in BNP at 3 months and 6 months after radiotherapy,and they had different levels of abnormal performance as palpitation,chest tightness,etc.This result further confirms that the abnormal electrocardiogram and ejection fraction can occur early in the radioactive heart injury.For patients with early cardiac radiation damage,we can take effective measures to reduce the further aggravation of radioactive heart damage.At the same time,the level of BNP in the patient can be evaluated for the evaluation of the radiation injury of Yanzhongchengdu and the prognosis.4.The expression level of ECG,LVEF,etc.has a certain effect on the heartradiation damage.Therefore,in the process of esophageal cancer radiotherapy,if the patient has an abnormal cardiac function index,the clinician should be alert to the occurrence of radioactive heart damage and adjust the radiotherapy plan in a timely manner according to the specific conditions of the patient.For example,changing the direction of the field of fire,adjusting the weight of the field of fire,and reducing the field of fire in a timely manner,the use of drugs to protect the function of the heart is used to prevent further aggravation of heart damage and improve the quality of life of the patient.