Published online Dec 27, 2023. doi: 10.4240/wjgs.v15.i12.2831
Peer-review started: September 14, 2023
First decision: November 2, 2023
Revised: November 15, 2023
Accepted: December 5, 2023
Article in press: December 5, 2023
Published online: December 27, 2023
Processing time: 104 Days and 4 Hours
Radiation enteritis, which often occurs during radiation-induced acute intestinal symptoms (RIAIS), is the most common and important complication during radiotherapy for cervical cancer. RIAIS caused by abdominal and pelvic radiotherapy will affect nutrient intake, digestion, absorption, and metabolism, leading to malnutrition or poorer nutritional status. In patients with malignant tumors, malnutrition can adversely affect the curative effect and response of radiotherapy by reducing radiosensitivity, affecting the accuracy of radiotherapy placement, and increasing the incidence of radiotherapy-related adverse reactions.
To verify the correlation between malnutrition caused by RIAIS and intestinal lipid metabolism disorders.
To investigate the changes in nutritional risk, skeletal muscle exhaustion, and lipid metabolism phenotype and their relationships during RIAIS.
Fifty patients with cervical cancer received external beam radiotherapy, and 15 patients received brachytherapy after external beam radiotherapy. The body weight, body composition parameters, nutritional risk screening (NRS) 2002 score, and blood biochemical indices of patients with cervical cancer during periradiation were tested by one-way repeated measures analysis of variance. Metabolomics analysis was used to identify the characteristic lipid metabolism pathways. The clinical factors affecting linoleic acid changes were screened using the generalized evaluation equation.
Of the 50 patients, 37 had RIAIS, including 34 patients with grade 1-2 RIAIS and 3 patients with grade 3 RIAIS. The NRS 2002 score of patients undergoing radiotherapy for cervical cancer continued to increase in the periradiation period, and 42 patients undergoing radiotherapy for cervical cancer had nutritional deficits (NRS 2002 score ≥ 3 points) by the end of radiotherapy. Correlation analyses revealed that body weight and body mass index changes were closely associated with body fat content (R2 = 0.64/0.51). The results of the univariate analysis showed that time of radiotherapy, percentage reduction of serum albumin, and percentage reduction of serum prealbumin were the key factors affecting skeletal muscle exhaustion (P < 0.05). Metabolomics analysis of fecal supernatant during the periradiation period of patients with cervical cancer was identified to be involved in the linoleic acid metabolic pathway, namely linoleic acid, cholic acid, arachidonic acid, and N-acetyl-L-benzene alanine.
Cervical cancer radiotherapy patients faced nutritional risks, and decreased serum albumin synthesis increased the risk of skeletal muscle exhaustion. Linoleic acid was a biomarker of high nutritional risk.
Further analyses revealed that the increased nutritional risk increased the linoleic acid content in the fecal supernatant, suggesting that linoleic acid is a biomarker in RIAIS patients with high nutritional risk.