The Influence Of The Radiotherapy On The Immune Function Of Patients With Chest Maglignant Tumor And The Relationship Of Related Factors During Radiotherapy

Objective: To investigate the influence of radiotherapy on the immunefunction of patients with chest maglignant tumor and analyse the relationshipof related factors during the radiotherapy.Methods: In this study, from May2011to January2012,44patients ofesophageal carcinoma and lung carcinoma which had been pathologicallyconfirmed in radiotherapy department of the Fourth Hospital of Hebei MedicalUniversity. All the patients had not received immunotherapy beforeradiotherapy. We detected the CD3, CD4, CD8, CD4/CD8and CD56inperipheral blood of patients by flow cytometry pre-radiotherapy andpost-radiotherapy, checked the hemogram before,during and after radiotherapywith interval of7to10days. The normal range of immune function using x±swas laid down by The flow cytometry Research Institute of the FourthHospital of Hebei Medical University from100healthy people. If any oneamong the CD3, CD4and CD4/CD8was lower than the normal range, wediagnosed the patient was immunocompromised. The linear accelerator wasuesd for radiotherapy and the plan was made with3-dimensional conformalradiotherapy(3D-CRT) and Intensity-modulated radiation therapy (IMRT).The target volume was plan target volume (PTV). If there were more than onePTV in the plan, it meant to remove the overlapping part of the total volume ofPTV. Patients were given the chemotherapy, anticancer Chinese patentmedicine therapy and immunotherapy according to condition of the patientsduring the radiotherapy. Patients were given symptomatic treatment when theyhad bone marrow depression. We took RECIST system to evaluate clinicaleffect. We used SPSS13.0for statistics analysis, and took P<0.05as the dadacompare be significantly different. Results:1．The index of immune function before radiotherapy was unrelatedwith age, gender, entity, pathological type, lymph node metastasis and surgicaloperation(P>0.05).2．In this study,65.9%of the44patients was immunocompromisedbefore radiotherapy and86.4%was immunocompromised when thepost-radiotherapy. The index of immune function was significantly differentbetween pre-radiotherapy and post-radiotherapy(P<0.05).3．In this study, the minimum of the target volume of the44patients was159.37cm~3and the maximum of the target volume of the44patients was758.91cm~3. The mean of the target volume of the44patients was427.33cm~3and the median of the target volume of the44patients was443.14cm~3. Wedivided44patients into>440cm~3group and≤440cm~3group according toapproximate median of the target volume440cm~3. The index of immunefunction after radiotherapy was significantly different between>440cm~3groupand≤440cm~3group (P<0.05). The radiotherapy dose was50.4Gy~70Gy/5~7weeks. We divided44patients into≥60Gy group and<60Gy group according to the median of the radiotherapy dose60Gy. Theindex of immune function after radiotherapy was not significantly different inthe two groups(P>0.05).4．During the radiotherapy,16patients received radiotherapy+chemotherapy+immunotherapy (group a).20patients received radiotherapy+Chinese patent medicine therapy+immunotherapy or radiotherapy+immunotherapy (group b) and8patients received radiotherapy (group c) in the44patients. The index of immune function after radiotherapy was significantlydifferent between group a and group c(P<0.05). The index of immune functionafter radiotherapy was significantly different between group b and group c(P<0.05). The index of immune function after radiotherapy was significantlydifferent between group a and group b (P<0.05).5．The hemogram of the patient in normal range was fewer and fewer.The lymphocyte had a downward trend.11patients had bone marrow depression in the16patients who recived chemotherapy during theradiotherapy.13patients have bone marrow depression in the28patients whodid not recive chemotherapy. The index of immune function after radiotherapywas significantly different between patients having bone marrow suppressionand patients having normal hemogram during the radiotherapy (P<0.05). Theindex of immune function after radiotherapy was significantly differentbetween patients be sensitive to symptomatic treatment when they had bonemarrow depression and patients be unsensitive to symptomatic treatment whenthey had bone marrow depression (P<0.05). The index of immune functionafter radiotherapy was not significantly different between patients having bonemarrow depression and patients having normal hemogram after radiotherapy(P>0.05). The index of immune function after radiotherapy was significantlydifferent about whether the lymphocyte of hemogram of the patient in normalrange after radiotherapy (P<0.05).6．Evaluate clinical effect post-radiotherapy:3patients were CR,36patients were PR,3patients were PD,2patients recived Prophylacticradiotherapy. the efficiency was92.86%in the group.Conclusion:1．The patient was immunocompromised pre-radiotherapy and theimmune situation get worse post-radiotherapy.2．The index of immune function after radiotherapy was related with thetarget volume, the index of immune function was worse when the targetvolume was bigger.3．Anticancer Chinese patent medicine therapy and immunotherapy topatient could improve the immune function of the patient.