The relationship between ghreline hormone, cytokines swept by chemoradiation and normal organ chemoradiotoxicity due to clinical chemoradiotherapy

ABSTRACTAim: The aim of this study is to compare the levels of ghreline hormone, TNF- ,IL-1, IL-6 and IL-8 before radiotherapy, at the last week of radiotherapy and 3 monthsafter radiotherapy in 30 patients with stomach, gall bladder and pancreas carcinomawho had concomittant chemoradiotherapy and to evaluate the relationship betweenthese measurements and grade 1-2-3 toxicity.Material and Methods: Stomach, gall bladder and pancreatic carcinoma patientshaving concomittant chemoradiotherapy who admitted to Çukurova University MedicalFaculty, Department of Radiation Oncology between the dates March 2011-May 2012were run into our study. Before the study, informed consents of all patients were takenand ethics committee approval was taken. All of the patients blood samples (not lowerthan 5 cc) were taken to measure plasma Ghreline, serum TNF- ? , IL-1, IL-6 and IL-8levels before radiotherapy, at the last week of radiotherapy and 3 months afterradiotherapy. Blood samples were centrifuged and frozen at -700C. When the controlsamples were collected, ELISA method was used for measurements. To evaluate thekidney and liver functions of patients, AST, ALT, LDH and creatinine levels weremeasured before radiotherapy, weekly during radiotherapy and 3 months afterradiotherapy.Results: 15 men and 15 women were taken into study. Histopathologically, 25(86.7 %) were adenocarcinoma, 5 (13.3 %) were squamous cell carcinoma. 16.7 % ofpatients were stage-1b; 30 % were stage-2a, 53.3 % were stage-3. Ghreline levels at thelast week of radiotherapy decreased when compared with its levels before radiotherapyand Ghreline levels increased 3 months after radiotherapy. The changes of Ghrelinelevels by time were found to be significant (p<0.001). The levels of preinflammatorycytokines TNF- ? , IL-1, IL6 and IL-8 increased at the last week of radiotherapy anddecreased 3 months after radiotherapy (p<0.001, p<0.001, p<0.001, p<0.001). When thepatients were divided into two groups such as stomach group and the other group; thechanges of blood Ghreline, TNF- ? , IL-1, IL-6, IL-8 levels by time were found to besignificant (Ghreline stomach group p<0,001, other group p=0.002, TNF- ? stomachgroup p=0.078, other group p=0.001, IL-1 stomach group p=0.001, other groupp=0.022, IL-6 stomach group p<0.001, other group p=0.058, IL-8 stomach groupp=0.006, other group p=0.069). There were no significant changes in transaminase andcreatinine levels which were measured before radiotherapy, weekly during radiotherapyand 3 months after radiotherapy. At the last week of radiotherapy, between groups whohad grade 1-2-3 toxicity, Ghreline and cytokine levels were measured and Ghrelinelevels decreased; cytokine levels increased due to toxicity at the last week ofradiotherapy. Ghreline decrease was distinctly more in the group who had grade 2-3toxicity when compared with the group who had grade 1 toxicity.Result: In this study, the changes of Ghreline and cytokine levels duringchemoradiotherapy and the relationship of chemoradiotherapy toxicity and thesemeasurements were associated. At the last week of therapy, appetite of patientsdecreased, nausea increased, velocity of weight loss increased. Ghreline levelsdecreased during radiotherapy parallel to this finding. At the same time, cytokine levelsincreased as toxicity increased paralel to this finding. After radiotherapy patientsgathered up slowly and appetite of patients increased. They started to gain weightparallel to this. So; after radiotherapy Ghreline levels increased and cytokine levelsdecreased.Key words: Ghreline, cytokines, cancer, chemoradiotherapy