| Objective: By monitoring the detection indicators of electrocardiogram,cTnI,myocardial enzyme spectrum,and ultrasonic cardiography,explored the value of early cardiac damage detected in radiotherapy of middle or lower esophageal cancer,and differences in heart damage caused by different irradiated volumes of the heart.Methods: This study selected thirty patients with middle or lower esophageal cancer who underwent three-dimensional conformal intensity modulated radiotherapy for the first time at the Radiotherapy Center of the First Affiliated Hospital of Wannan Medical College from January 2019 to December 2019.The research subjects were selected strictly according to the following criteria: The middle or lower esophageal cancer patients were diagnosed by auxiliary examination such as imaging,gastroscopy,histopathology,and cytology,the pathological types were squamous cell carcinoma;The KPS score ?70 points,age ?75 years;All patients received chest 3-dimensional conformal intensity modulated radiation therapy for the first time;Received a total dose of 60 Gy,routinely divided(1 time a day,1.8-2Gy each time,5 times a week),expected survival> 6 months;Patients' blood routine indexes,liver and kidney function and related cardiovascular examination indexes were normal,no history of cardiovascular disease,endocrine system disease.Among them,23 were male patients and 7 werefemale patients.Aged 50-75 years,with an average of 69.7 years.The ECG,troponin I,myocardial enzyme spectrum,and echocardiogram of the above patients were detected before and after radiotherapy.Statistical analysis was performed on the obtained data to explore the value of the above indicators in the detection of early cardiac damage in middle and lower esophageal cancer radiotherapy,and the correlation between cardiac damage caused by conformal irradiation and the dose and volume of radiation.Results: 1.In this study,sinus tachycardia occurred in 1 case(3.3%),bradycardia in 2case(6.6%),ST-T segment changes in 6 cases(20%),and T wave changes in 3 cases(10%)?According to the American Radiation Oncology Group RTOG's acute radiation injury classification criteria and the clinical manifestations of patients: 1 patient diagnosed as 1 grade acute radiation injury(3.3%)and 9 patients diagnosed as 2 grade acute radiation injury(30%).2.Patients with RIHD in this study,serum cTnI increased in 7 cases(23.3%)after radiotherapy,and 3 cases(10%)exceeded the upper limit of serum cTnI value after radiotherapy.The serum cTnI of patients before radiotherapy was 0.0050 ± 0.0073,and the serum cTnI of radiotherapy 0.0097 ± 0.0150.After paired sample t test,troponin after treatment was higher than before treatment,the difference was statistically significant(p <0.05).Statistically significant increase in serum cTnI after radiotherapy.Seven patients with elevated cTnI had radioactive heart damage.3.Patients with RIHD in this study,AST increased in 13 cases(43.3%),and 1 case had an AST value above the upper limit of normal(3.3%);CK increased in 21 cases(70%),and values exceeded the upper limit of normal in 3 cases(10%);CK-MB increased in 20 cases(66.7%),and the number exceeded the normal upper limit in 0cases.The serum CK of patients before radiotherapy was 72.73 ± 46.86,and the serum CK was 79.23 ± 57.13 after radiotherapy.The CK was significantly higher than that before radiotherapy(p <0.05),and the serum CK elevation before and after radiotherapy was statistically significant.The serum CK-MB of patients before radiotherapy was10.20 ± 4.66,and the serum CK-MB of patients after radiotherapy was 10.93 ± 4.76.CK was significantly higher than that before radiotherapy(p <0.05).There was no significant difference in AST,LDH,and HBDH before and after radiotherapy(p>0.05).Among 21 patients with elevated CK,14(66.7%)patients had radioactive cardiac injury;among 21 patients with elevated CKMB,14 patients(66.7%)had radioactive cardiac injury.4.In this study,ultrasonic cardiography finded 6(20%)patients had mild valvular reflux,1(3.3%)patients had moderate valvular reflux,9(30%)patients had left ventricular diastolic dysfunction,and 1(3.3%)patients had left ventricular systolic hypofunction.Among the 30 patients in this subject,15(50%)patients experienced a decrease in LV-EF values after radiotherapy,1(3.3%)patients had lower than normal low values after treatment,and LV-EF values of patients before radiation 63.43 ± 5.09.The LV-EF of the patients after radiotherapy was 61.67 ± 7.68(p> 0.05).Therefore,there was no statistically significant decrease in LV-EF compared with that before radiotherapy.5.According to the Common Adverse Event Evaluation Criteria(CTCAE)version5.0 general term of adverse events,combined with the patient's auxiliary examination and clinical manifestations,20 patients developed RIHD(66.7%)and 10 patients did not develop RIHD(33.3%)..According to the X2 test,the differences between RIHD and non-RIHD groups caused by various clinical factors were analyzed.There was no difference in gender and tumor pathological grade between the occurrence group and the non-occurrence group(P> 0.05).After nonparametric test analysis,the differences in age,KPS score and distance between lump and incisor between RIHD and non-RIHD groups were not statistically significant(p> 0.05).6.In this study,the heart V40 of patients with RIHD was 16.10±6.16,the heart V40 of patients with non-RIHD was10.40±6.44,independent samples the t-test analysis showed that there was a significant difference in cardiac V40 between the patients in theoccurrence group and the non-occurrence group(P <0.05),while there was no significant statistical difference in the cardiac Dmin,Dmax,and Dmean of the patients in the occurrence group and the non-occurrence group(P> 0.05).Conclusion: 1.cTnI,CK,and CKMB have important predictive significance for heart injury caused by radiotherapy for lower or middle esophageal cancer.2.Middle or lower segment esophageal cancer radiotherapy for cardiac injury is positively correlated with cardiac irradiation volume.3.Cardiac diastolic function is more susceptible to systolic function after radiotherapy for lower or middle esophageal cancer. |
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