Observation Of Radiation Injury To The Gastric Or Duodenal By The Radiotherapy To Pancreatic Carcinoma

【Objective】Gastric and duodenal mucosal injury by the radiotherapy-induced to pancreaticcarcinoma is rarely reported,it′s lack of objective evaluation for gastric or duodenalmucosa injury induced by radiotherapy currently.We retrospectively analyzed the typeand extent of gastric or duodenal mucosal injury induced by radiotherapy and itsinfluencing factors through the clinical data we collectted that pancreatic cacinomalwho underwent gastroscopy after radiotherapy of our hospital in rencent five years.【Methods】1.Patient selectionCollected31patients of pancretic cacinomal with gaotroscopy after radiotheraphyfrom January2008to January2013in our hospital.Patients were excluded if they hadgastric or duodenal ulcers.18males,13females, aged between44-75years old,averageage is59years old.All patients with pancreatic carcinomal were diagonosed by laborarytests or imaging (CT,MRI,PET,et al)or pathological.2.Treatment15cases were treatmented with γ-ray,5cases with three-dimensional conformalradiotherapy,11patients with Helical Tomo Therapy(TOMO).Prescribed dose:γ-ray:around50%of the dose line,GTV:45Gy/15f-51Gy/17f;3-D:surrounding90%isodoseline,CTV/GTV:50Gy/60Gy/25f;TOMO:surrounding95%isodose line,CTV/GTV:50Gy/60Gy/20f.All patients were treatmented with conventional fractionation,1f/d,5f/1wk.3.Evaluation index3.1.Clinical symptoms observation:according to RTOG/EORTC standard grade,itwas divided into acute gastrointestinal toxicity and chronic gastrointestinal toxicity.3.2.gastroscopy observation was divided into class I-IV by the endoscopicgrading.All patients underwent endoscopic histopathological biopsy.4.Statistical Methods The table was estabished for statistics,exact test was used for statistical analysis,P<0.05.【Result】1.Observation of clinical symptoms:such as abdominal distension,anorexia,acidreflux,nausea,vomiting,abdominal pain was more common.Rate of acute gastrointestinaltoxicity was71.0%,rate of gastrointestinal toxicity of grade3-4:19.4%in acutephase,20.0%in chronic phase.2.Gastroscopy observations:the total rate of gastrointestinal injury was87.1%,therate of gastric or duodenal mucosa injury of grade III-IV was67.8%.Endoscopicperformance:4cases of grade I(no gastric or duodenal mucosa injury);6cases of gradeII (mild stomach or duodenum mucositis);3cases of grade III (erosive gastritis);17casesof grade IV:6cases with gastric ulcer,1case with gastric ulcer with gastric antrum todeformation;5cases with duodenal ulcer,1case with anastomotic ulcer,4cases with theduodenal ulcer and merger narrow;and no case with concomitant gastrointestinal ulcers.All cases were in line with inflammatory or ulcerative changes confirmed byhistopathology endoscopic biopsy.1case of duodenal stenosis was caused by tumorinvasion,and was confirmed by histopathological examination.The gastroscopy observations gastric or duodenal injury induced by radiotheraphywith three different techniques(γ-ray,3-D,TOMO):the total rate of gastric or duodenalmucosa injury:γ-ray therapy vs3-D(80.0%vs80.0%,P>0.0167),γ-ray therapy vsTOMO(80.0%vs72.7%,P>0.0167),3-D vs TOMO(80.0%vs72.7%,P>0.0167);the rateof gastric or duodenal mucosa injury of grade III-IV:γ-ray therapy vs3-D(66.7%vs40.0%,P<0.0167),γ-ray therapy vs TOMO(66.7%vs63.7%,P<0.0167),3-D vsTOMO(40.0%vs63.7%,P>0.0167).γ-ray radiotheraphy dose was51Gy(10patients),48Gy(3cases),45Gy(2case),the rate of gastric or duodenal mucosa injury was(90%vs100%vs100%);the rate of gastric or duodenal mucosal injury of grade III-IVwas(80%vs66.7%vs50%),three groups compare with each other,P<0.0167.Thepatients with postoperative radiotherapy was16cases,15cases no surgery history:therate of gastric or duodenal mucosal injury was(87.5%vs66.7%,P>0.05);the rate ofgastric or duodenal mucosal injury of grade III-IV was(68.8%vs53.4%,P>0.05).Concurrent chemoradiotherapy with GEM was9cases,22cases with non-chemoradiotherapy, the rate of gastric or duodenal mucosal injury was(66.7%vs91.9%,P>0.05);the rate of gastric or duodenal mucosal of grade III-IV was(55.6%vs 72.7%,P>0.05).16cases was given gastrointestinal mucosal protective agent duringradiotherapy,15cases with no gastrointestinal mucosal protective agent,the rate ofgastric or duodenal mucosal injury was(68.7%vs100%,P=0.04),the rate of gastric orduodenal mucosal injury of grade III-IV was(50%vs86.7%,P=0.053).10cases wasgiven Amifostine during radiotherapy,15cases with no-Amifostine,the rate of gastricor duodenal mucosal injury was(85.7%vs82.4%,P>0.05),the rate of gastric orduodenal mucosal injury of grade III-IV was(64.3%vs70.6%,P>0.05).Co-morbidities(e.g. Diabetes mellitus, hypertension,inflammatory bowel disease)was14cases,17cases with Co-morbidities,the rate of gastric or duodenal mucosal injurywas(78.6%vs76.5%,P>0.05),the rate of gastric or duodenal mucosal injury of gradeIII-IV was(64.2%vs58.8%,P>0.05).Patient with smoking was8cases,23cases withnon-somking,the rate of gastric or duodenal mucosal injury was(87.5%vs82.6%,P>0.05),the rate of gastric or duodenal mucosal injury of grade III-IV was(87.5%vs60.8%,P>0.05).【Conclusion】It’s a high incidence of gastrointestinal injury induced by radiotheraphy inpancreatic cacinomal,especially for acute gastrointestinal toxicity.The rate ofradiotheraphy-induced gastric or duodenal mucosal injury observed by gastroscopy ishigher than diagnosed by clinical symptoms.We analysis the factors that affectradiotheraphy-induced gastrointestinal injury,the result shows radiation dose affect theincidence of gastric or duodenal mucosal injury,with the radiation dose increased,thehigher incidence of gastric or duodenal mucosal injury;radiotherapy technology didhave an impact on radiotheraphy-induced gastric or duodenal mucosal injury,but thedifference was not statistically significant.Abdominal surgery,Co-morbidities,smokingwas not proved to be the risk factors for radiotheraphy-induced gastric or duodenalmucosal injury;gastric or duodenal mucosal mucosal protective agent was a favorablefactors for radiotherapy-induced gastrointestinal injury,while Amifostine was not provedto lessen the gastric or duodenal mucosal injury induced by radiotheraphy in this study.