Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2023; 29(8): 1344-1358
Published online Feb 28, 2023. doi: 10.3748/wjg.v29.i8.1344
Establishment of a prediction model for severe acute radiation enteritis associated with cervical cancer radiotherapy
Chen-Ying Ma, Jing Zhao, Guang-Hui Gan, Xiao-Lan He, Xiao-Ting Xu, Song-Bing Qin, Li-Li Wang, Li Li, Ju-Ying Zhou
Chen-Ying Ma, Jing Zhao, Guang-Hui Gan, Xiao-Lan He, Xiao-Ting Xu, Song-Bing Qin, Li-Li Wang, Li Li, Ju-Ying Zhou, Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215123, Jiangsu Province, China
Ju-Ying Zhou, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou 215123, Jiangsu Province, China
Author contributions: Ma CY and Zhao J contributed to conceptualization and methodology; He XL and Gan GH contributed to data curation; Ma CY contributed to formal analysis; Ma CY, Zhou JY contributed to funding acquisition; Zhou JY, Xu XT, Qin SB contributed to project administration; Zhou JY, Xu XT, Qin SB, Wang LL, and Li L contributed to resources; Xu XT and Qin SB contributed to supervision; Ma CY contributed to validation and visualization; Ma CY and Zhao J contributed to roles/writing-original draft; Ma CY contributed to writing-review and editing.
Supported by the National Natural Science Foundation of China, No. 81602792 and No. 81602802; Project of State Key Laboratory of Radiation Medicine and Protection, Soochow University, No. GZK1202101; Suzhou Science and Technology Development Plan Project, No. KJXW2020008; and BOXI Natural Science Cultivation Foundation of China of the First Affiliated Hospital of Soochow University, No. BXQN202107.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of The First Affiliated Hospital of Soochow University Medical Ethics Committee [approval No. 2016(100)].
Informed consent statement: All enrolled patients provided signed informed consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The datasets generated and analyzed during the present study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ju-Ying Zhou, MD, Radiation Oncology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215123, Jiangsu Province, China. zhoujuyingsy@163.com
Received: October 17, 2022
Peer-review started: October 17, 2022
First decision: January 3, 2023
Revised: January 13, 2023
Accepted: February 14, 2023
Article in press: February 14, 2023
Published online: February 28, 2023
Processing time: 133 Days and 1.4 Hours
ARTICLE HIGHLIGHTS
Research background

Radiation enteritis (RE) not only seriously affects the quality of life of patients, but it also leads to radiotherapy intolerance or termination of radiotherapy. However, data on the clinical efficacy and side effects of volumetric modulated arc therapy (VMAT) for cervical cancer are limited.

Research motivation

If the incidence of RE in patients can be predicted in advance, and targeted clinical preventive treatment can be carried out, the side effects of radiotherapy in cervical cancer patients can be significantly reduced. Furthermore, accurate prediction of RE is essential for the selection of individualized radiation dose and the optimization of the radiotherapy plan.

Research objectives

To analyze the relationships between severe acute RE (SARE) of cervical cancer radiotherapy and clinical factors and dose-volume parameters retrospectively.

Research methods

We included 50 cervical cancer patients who received VMAT from September 2017 to June 2018 in the Department of Radiotherapy at The First Affiliated Hospital Soochow University. Clinical and dose-volume histogram factors of patients were collected. Logistic regression analysis was used to evaluate the predictive value of each factor for SARE. A nomogram to predict SARE was developed (SARE scoring system ≥ 3 points) based on the multiple regression coefficients; validity was verified by an internal verification method.

Research results

Gastrointestinal and hematological toxicity of cervical cancer VMAT gradually increased with radiotherapy and reached the peak at the end of radiotherapy. The main adverse reactions were diarrhea, abdominal pain, colitis, anal swelling, and blood in the stool. There was no significant difference in the incidence of gastrointestinal toxicity between the radical and postoperative adjuvant radiotherapy groups (P > 0.05). There were significant differences in the small intestine V20, V30, V40, and rectal V40 between adjuvant radiotherapy and radical radiotherapy after surgery (P < 0.05). Univariate and multivariate analysis revealed anal bulge rating (OR: 14.779, 95%CI: 1.281-170.547, P = 0.031) and disease activity index (DAI) score (OR: 53.928, 95%CI: 3.822-760.948, P = 0.003) as independent predictors of SARE.

Research conclusions

Anal bulge rating (> 0.500 grade) and DAI score (> 2.165 points) can predict SARE. The nomogram shows potential value in clinical practice.

Research perspectives

From the perspective of precision medicine, it will also be necessary to combine biological factors, such as individual genomics, proteomics, metabolomics, microbiomics, real-time dosimetry, and a wider range of clinical parameters to establish comprehensive predictive models. This study is a prospective study with a small sample size. In the later stage, we will expand the sample size, conduct prospective cohort studies, and use external validation methods to reduce data selection bias and increase test efficiency.