J Gynecol Oncol.  2012 Apr;23(2):103-109. 10.3802/jgo.2012.23.2.103.

Changes in biologic markers of oxidative stress and plasma endotoxin levels in gynecologic cancer patients treated with pelvic radiotherapy: a pilot study

• Kim HJ
• Kim JH
• Ha SW
• Wu HG
• Choi JH
• Lee KM
• Kang SW

• KMID: 2177583
• DOI: http://doi.org/10.3802/jgo.2012.23.2.103

Abstract

OBJECTIVE
We conducted a pilot study to evaluate the effects of pelvic radiotherapy on biologic markers of oxidative stress and plasma endotoxin levels, and to assess the relationship between the changes of such factors and radiotherapy-related complications.
METHODS
Twelve gynecologic cancer patients who were treated via pelvic radiotherapy with or without concurrent chemotherapy were enrolled in this study. Biologic markers of oxidative stress, such as glutathione (GSH) and oxidized glutathione (GSSG), as well as endotoxin levels, were measured weekly during treatment. Subjective symptoms were assessed using the Korean version of the EORTC QLQ-C30 at the baseline and on the 5th week of radiotherapy.
RESULTS
No changes were noted in the level of GSH in whole blood, but the GSH/GSSG ratio was reduced dramatically after the initiation of radiotherapy. The mean plasma endotoxin for all patients tended to increase and persisted during radiotherapy, and the number of patients who evidenced clinically significant endotoxin levels (defined as >0.005 EU/mL) also increased. Nausea/vomiting and diarrhea were significantly changed (p=0.019 and p<0.001, respectively). A significant relationship was noted to exist between the changes in the endotoxin level and nausea/vomiting (p=0.001). However, such symptoms did not correlate with the changes of oxidative stress markers.
CONCLUSION
Pelvic radiotherapy oxidized the GSH redox system and increased plasma endotoxin. Further investigations containing interventional and longitudinal studies will be required to assess the effects of the changes in oxidative stress markers and endotoxin on radiotherapy-related adverse events.

Keyword

Adverse effects; Endotoxins; Oxidative stress; Radiotherapy

MeSH Terms

Biomarkers
Diarrhea
Endotoxins
Glutathione
Glutathione Disulfide
Humans
Longitudinal Studies
Oxidation-Reduction
Oxidative Stress
Pilot Projects
Plasma
Endotoxins
Glutathione
Glutathione Disulfide

Figure

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  Fig. 1 Glutathione (GSH)/oxidized glutathione (GSSG) ratio during radiotherapy. GSH/GSSG ratio=GSH/GSSG.

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  Fig. 2 Blood endotoxin level (A) and positive rate (B) in patient subjects during radiotherapy. Endotoxin was expressed as mean±standard error. Endotoxin level between baseline and at 5th week of treatment was statistically significant (p<0.05) according to the results of the t-test.

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  Fig. 3 The change in the level of endotoxin was associated significantly with nausea/vomiting (p=0.001; (A) arrow head: 3 patients overlapped), but not with diarrhea (p=0.196; (B) arrow: 2 patients overlapped). Endotoxin final-baseline, difference in the endotoxin values between final and baseline week; Nausea and vomiting severity, difference in the severity of nausea and vomiting between final and baseline week; Diarrhea severity, difference in the severity of diarrhea between final and baseline week.

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