Antagonistic Effect And Possible Causes Of Thalidomide On Acute Radiation-Induced Oral Mucositis Of Nasopharyngeal Carcinoma

Objective: To study the antagonistic effect and possible causes of thalidomide on patients with acute radiation-induced oral mucositis(RIOM)of nasopharyngeal carcinoma(NPC).Methods:88 patients with nasopharyngeal carcinoma received initial radical radiotherapy in Shaoyang hospital affiliated to University of South China from January 2019 to November 2020 were randomly divided into two groups.The control group was gargled with sodium bicarbonate from the first day of radiotherapy to the end;the experimental group took thalidomide every night on the basis of the control group.In the meantime,the time,degree and adverse reactions of acute radiation oral mucositis were under observation and the Karnofsky(KPS)scores of the two groups of patients before and after radiotherapy were evaluated.Furthermore,Enzyme linked immunosorbent assay(ELISA)was used to detect serum tumor necrosis factor α(TNF-α)and interleukin-1β(IL-1β)levels 1 day before radiotherapy,15 th day,and 1 day after radiotherapy.Results:(1)The incidence of acute RIOM in the experimental group was lower than that in the control group during radiotherapy(P<0.05),the incidence of acute RIOM of grade 2 and below was higher than that of the control group(P<0.05),and the incidence of grade 3 and above was lower than that of the control group(P<0.05).(2)The median time of acute RIOM in the experimental group was later than the control group during radiotherapy(P<0.05).(3)Between the two groups,there was a time difference in serum TNF-α and IL-1β levels(F=121.994,P=0.000<0.01;F=84.179,P=0.000<0.01)and a group difference(F=23.410,P=0.000<0.01;F=4.902,P=0.029<0.05)and interaction(F=7.409,P=0.002<0.01;F=4.218,P=0.016<0.05).Serum IL-1β levels of the two groups of patients elevated with the radiotherapy time,and the increase rate of the control group was higher.On the 15 th day of radiotherapy and after the completion of radiotherapy,the serum TNF-α and IL-1β levels of the two groups of patients were significantly higher than before radiotherapy(P<0.01);the serum levels of TNF-α and IL-1β rose on the 1st day after radiotherapy compared with the 15 th day after radiotherapy(P>0.05).Simple effect test showed that the levels of serum TNF-α and IL-1β in the two groups were similar one day before radiotherapy(P>0.05).On the 15 th day and one day after radiotherapy,the levels of serum TNF-α and IL-1β in the control group were higher than those in the experimental group(P<0.05).(4)Serum levels of TNF-α and IL-1β in patients with grade 3-4 acute RIOM are higher than those of patients with grade 0-2(P<0.05);the incidence of acute RIOM was positively correlated with the levels of serum TNF-α and IL-1β after radiotherapy,and the correlation coefficients r were 0.642 and 0.517,respectively,P<0.01.(5)There was no significant difference in the KPS scores of the two groups before radiotherapy(P>0.05).After radiotherapy,the KPS scores of the two groups of patients were lower than those before radiotherapy(P<0.05).The control group decreased dramatically compared with the test group(P<0.05).(6)There was no obvious difference in the incidence of leukopenia,thrombocytopenia,lethargy,constipation,peripheral neuritis and nausea between the two groups(P>0.05).Conclusions:(1)Thalidomide is a safe and reliable drug that can reduce the severity of acute oral mucositis caused by radiotherapy for nasopharyngeal carcinom.(2)Decreasing the levels of serum TNF-α and IL-1β may be one of the reasons why thalidomide reduces the severity of acute oral mucositis caused by radiotherapy for nasopharyngeal carcinoma.