| ?Objective? This paper describes the endoscopic observation of pancreatic cancer radiotherapy induced gastroduodenal radioactive injury,and preliminary analysis the risk factors of radiation-induced ulcer after radiotherapy in patients with pancreatic carcinoma,and evaluate the relationship between acute gastrointestinal symptom and radiation-induced gastroduodenal injury.?Methods? 1.Collect a total of 135 cases of radiotherapy in patients with pancreatic carcinoma between February 2010 and May 2015 at China Air Force General Hospital.Self-comparative study of gastroscopic findings was performed on 112 patients with pancreatic carcinoma who accepted gastroscopy before and after radiotherapy.2.Collect the patient's general information such as gender,age,KPS score,tumor location,tumor size,history of ulcer,surgery history of reducing jaundice,history of smoking,diabetes,etc.3.Chemoradiotherapy method: S-1(Tegafur Gimeracil Oteracil Potassium Capsule),po 50 mg bid,D1-D14,21 d cyclicity.Gemcitabine,iv 1g/m2 qw,21 d cyclicity.4.Radiotherapy method: Gamma Knife,Three Dimensional Conformal Radiation Therapy(3-D Therapy),Intensity Modulated Radiation Therapy(IMRT)and helical tomotherapy(TOMO).5.Acute gastrointestinal symptoms(Radiotherapy started to 3 months)were graded by the Common Toxicity Criteria for Adverse Events,version 4.0(CTCAE 4.0),and record the start time of gastrointestinal symptoms.Record symptomatic treatment,such as enhance appetite,anti-nausea,promoting digestion function,help defecation,etc.6.Strictly defined gastroduodenal radioactive injury criteria.Gastroscopic performance described respectively.Explore the incidence of radiation-induced inflammation,ulceration,hemorrhage and gastric retention.Gastroscopic observed injury grading by six points method.7.Statistical analysis: single factor analysis,such as T-test,Chi-square test,Fisher's exact test were used to analyze whether the clinical factors are likely to affect the radiation-induced ulcer or not.Put the meaningful factors into the logistic regression analysis model for analysis.The correlation of classification between acute gastrointestinal symptoms and gastroscopic observed radiation-induced injury is assessed by Kruskal-Wallis Test and Spearman correlation analysis.All the statistical analyses were performed using SPSS version 22.0 software for Mac OS.P values less than 0.05 were considered to be statistically significant.?Results? 1.The median time of post-radiotherapy gastroscopy examination time was 1 month after radiotherapy.The total incidence of radiation-induced inflammation is 57.1%(64/112),including radiation-induced gastritis in 44 patients(39.3%)and radiation-induced duodenitis in 40 patients(35.7%).The total incidence of radiation-induced ulcer is 42.0%(47/112),including radiation-induced gastric ulcer in 22 patients(19.6%)and radiation-induced duodenal ulcer in 26 patients(23.2%).Majority of the radiation-induced ulcers were observed in gastric antrum(59.1%,13/22)and duodenal bulb(57.7%,15/26).The incidence of local stenosis with ulcer and scarring is 6.3%(7/112).Ten patients(8.9%)had active gastroduodenal hemorrhage in the observation of gastroscopy.Eight patients(7.1%)had gastric retention.2.In this study,17 cases with at least 2 times gastroscopy examination after radiotherapy.The median time of first and last post-radiotherapy gastroscopy examination time were 0.32 and 4 month after radiotherapy,respectively.Compared with the previous gastroscopy examination after radiotherapy,the last post-radiotherapy gastroscopy examination showned less acute inflammation(11VS8),but more radiation-induced ulcer(3VS7).3.The history of ulcer and grade 2 or more acute gastrointestinal symptoms associated with radiation-induced ulcer,P values were 0.040 and 0.032,respectively.The rest clinical factors had no influence on the radiation-induced ulcer(P>0.05).4.The classification of acute gastrointestinal symptoms are correlate with the classification of gastroscopic observed radiation-induced injury(P=0.015).Proved by Spearman correlation analysis,they are low positive correlation(P=0.002,r=0.295).5.The incidence of radiation-induced ulceration of radiotherapy group,S-1 group and gemcitabine group are 44.1%(26/59),50.0%(10/20)and 46.7%(7/15),respectively.Radiation-induced ulceration incidence was no statistical difference between the three groups(P=0.897).6.Gastroscope median time was 2.5 months after radiotherapy.In 10 patients with active bleeding under gastroscope,fist reason of gastroduodenal hemorrhage is radioactive duodenal ulcer,the second is radiation gastritis.?Conlusion? 1.Gastroduodenal radioactive injury are occurring commonly,mainly composed of inflammation,ulcer.We suggest that patients do gastroscopy examination routinely after radiotherapy(within 1 month)and in the follow-up period.Gastroscopy can find subclinical symptoms ulcer timely.2.Patients who has got grade 2 or more acute gastrointestinal symptoms or has the history of ulcer we should be alert to the occurrence of radiation-induced ulcer.3.Patients who has got grade 2 or more acute gastrointestinal symptoms we should be alert to the occurrence of radioactive ulcer.We can't make our evaluation on toxicity of gastroduodenal entirely depending on the clinical symptoms,endoscopic diagnosis is the gold standard of estimate of gastroduodenal radioactive injury.4.Considered from the safety of gastroduodenal angle,patients can according to their self-condition for choosing S-1 or gemcitabine chemotherapy.The rate of radiation-induced ulceration occurrence was no significant difference between the concurrent chemoradiotherapy treatment was adopted or not.5.Gastroscope can timely found gastroduodenal hemorrhage caused by the radiotherapy,and to avoid or reduce the serious adverse events,reduce the risk of death. |
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