| ??Correlation analysis between physical parameters of cervical cancer radiotherapy and acute radiation enteritisPurpose:Cervical cancer is the most common gynecological tumor,and radiotherapy and chemotherapy is the mainly therapeutic method.This study analyzed the physical parameters of radiation therapy in patients with cervical cancer to investigate the relationship between physical parameters and the incidence of radiation enteritis after radical or postoperative adjuvant radiotherapy in patients with cervical cancer.Method:A total of 51 patients(one patient was excluded because of refusing to conduct the protocol after enrollment,a total of 50 patients were included)with FIGO IB to IV cervical cancer who underwent radical or postoperative radiotherapy in the Department of Radiotherapy,the First Affiliated Hospital of Soochow University from September 2017 to June 2018,were selected.The patient's symptoms of radiation enteritis(including diarrhea,abdominal pain,colitis and anal pain)were grouped using NCI-CTCAE acute radiation enteritis classification,and the radiological physical parameters of the organs including the rectum,colon and small intestine were collected using the TPS system.The clinical data of the patients were statistically analyzed with the SPSS 17.0 statistical software package.The chi-square test was used to analyze the relationship between the radiological parameters and the incidence of radiation enteritis.Result:1.Compare the pathological stage,age,radiotherapy(radical radiotherapy or postoperative adjuvant radiotherapy),mass size,differentiation degree,muscle depth and blood vessel invasion(LVSI)of 50 patients,p-value is greater than 0.05.There was no statistical difference.The incidence of radiation enteritis was high in patients receiving concurrent chemotherapy(p<0.05),which is statistical differences.2.Correlation between physical parameters of external irradiation and incidence of radiation enteritis:(1)As the absolute volume of the small intestine and the absolute volume of the left colon become bigger,the incidence of moderate diarrhea increased,the difference was statistically significant(P<0.05);(2)As the absolute volume of small intestine and small intestine V20 become bigger,the incidence of abdominal pain increased,the difference was statistically significant(P<0.05);(3)As the absolute volume of the left colon becomes bigger,the incidence of colitis increased,the difference was statistically significant(P<0.05);(4)As the rectal V40 becomes bigger,the incidence of anal pain increased,the difference was statistically significant(P<0.05).3.The relationship between the physical parameters of post-loading treatment and the incidence of radiation enteritis:(1)median D2cc rectal:64.34Gy;median DO.1cc rectal:74.56Gy;HR-CTV90 median:75.11 Gy.(2)The higher the rectal D2cc,rectal DO.lcc and HR-CTV90,the higher the incidence of diarrhea(P<0.05),the difference was statistically significant.Conclusion:1.The clinical data of patients including pathological staging,age,radiotherapy,mass size,degree of differentiation,depth of myometrium,LVSI were not associated with the occurrence of radiation enteritis,but the incidence of radiation enteritis in patients with concurrent chemotherapy was significantly higher than that of patients with non-synchronized chemotherapy.2.Physical parameters of patients with cervical cancer after radical or post-operative adjuvant radiotherapy are significantly correlated with the occurrence of acute radiation enteritis.The absolute volume of small intestine and left colon can be used as clinical indicators for predicting acute radiation enteritis.3.The therapeutic parameters of rectal D2cc,rectal DO.lcc and HR-CTV90 which observed by image-guided three-dimensional brachytherapy planning system are significantly correlated with the occurrence of acute radiation enteritis,suggesting that these physical parameters can be used as predictors of clinical acute radiation enteritis.??The study of the correlation between the expression of metabolites and aute radiation enteritis in patients with cervical cancerPurpose:Radiation enteritis(RE)is the most common radiotherapy adverse reaction in cervical cancer radiotherapy,and its pathogenesis is complex and has not yet been clarified.In this study,non-targeted metabolomics was used to study the changes of metabolites in feces before,during,and after radiotherapy in patients with cervical cancer who underwent total pelvic radiotherapy.The changes in intestinal metabolites were correlated with the occurrence of radiation enteritis.Relationships provide new ideas and methods for the prediction of radiation enteritis.Method:A total of 51 patients(one patient was excluded because of refusing to conduct the protocol after enrollment,a total of 50 patients were included)who received cervical cancer radiotherapy at the First Affiliated Hospital of Soochow University from September 2017 to June 2018,were selected.fecal samples were collected at 4 time points during radiotherapy(start of radiotherapy,two weeks of radiotherapy,four weeks of radiotherapy,and end of radiotherapy).A total of 204 stool samples were collected for testing.Fecal samples were analyzed by non-targeted metabolomics using liquid chromatography-mass spectrometry(LC-MS).Statistical methods such as partial least squares-discriminant analysis(PLS-DA),agglomerate hierarchical clustering,etc.are used to identify metabolites in feces,and Pearson correlation coefficients are used to analyze metabolites.Correlation,using the MetPA database to condense and topologically analyze metabolic pathways to identify possible bioturbative metabolic pathways.Result:1.Through non-targeted metabolomics analysis of liquid chromatography-mass spectrometry(LC-MS),a total of 5770 metabolic peaks were detected and 121 significant metabolites of differential metabolites were identified,of which 77 metabolites were up-regulated,44 Metabolite expression is down-regulated.2.By comparing the changes in metabolites in the fecal supernatant of patients at four time points during radiotherapy,a total of 19 differential metabolites with significant changes at four time points of radiotherapy were screened,including:1-methylxanthine,linoleic acid,5-aminovaleric acid,phenethylamine,styrene,N-acetylglutamate,norron,4-acetylaminobutyric acid,N-acetyl-L-phenylalanine,daidzein,cholic acid,peanut four Alkenoic acid,methyl leucine,N-formyl-L-methionine,quercetin,phenylalanine,gluconic acid,melibiose and a-CMBHC.3.Using the MetPA database to analyze the pathways of differential metabolites,a total of 4 metabolic pathways(Pathway impact>0.1)were screened:phenylalanine tyrosine metabolic pathway,niacin and nicotinamide metabolic pathway,linoleic oil Acid metabolism pathway,lysine degradation metabolic pathway.Conclusion:1.During the radiotherapy of cervical cancer patients,the metabolites in the feces changed significantly,and the changes were statistically significant.Different metabolic indicators were up-regulated and down-regulated during different periods of radiotherapy.2.Four metabolic pathways in cervical cancer patients changed significantly,including phenylalanine tyrosine metabolic pathway,niacin and nicotinamide metabolic pathway,linoleic acid metabolic pathway,and lysine degradation metabolic pathway.Among the differential metabolites involved in the phenylalanine tyrosine metabolic pathway,the linoleic acid metabolic pathway and the lysine degradation metabolic pathway,the expression in the fecal supernatant was significantly up-regulated with radiotherapy;niacin and nicotinamide metabolites are significantly down-regulated in the metabolic pathway.3.Use data mining methods to explore the metabolic pathways of the disorder for analysis.(1)The phenylalanine tyrosine metabolic pathway promotes the repair of intestinal damage during radiotherapy;(2)Linoleic acid is involved in lipid peroxidation,and its expression is up-regulated,which may be related to the occurrence of radiation enteritis;(3)In the nicotinic and niacinamide metabolic pathways,changes in metabolites suggest aggravation of radiation-induced intestinal damage;(4)Lysine acts as an intestinal protective molecule,and the up-regulation of degradation products suggests aggravation of radiation-induced intestinal damage. |
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