[Impact of diabetes mellitus on clinicopathological factors and relation with radiation pneumonitis in 332 patients with lung cancer]

Impact of diabetes on gastrointestinal and urinary toxicity after radiotherapy for gynecologic malignancy

Objective

Although diabetes is a common co-morbidity in patients with gynecologic cancer, information about its impact on radiation toxicity in patients with gynecologic cancer treated with external pelvic irradiation is scarce. We aimed to investigate the relation of diabetes with acute toxicity in patients with gynecologic tumors who underwent pelvic +/- paraaortic radiotherapy.

Materials and Methods

One hundred twenty-nine patients with endometrium or cervix carcinoma were enrolled in the study. Demographic features, presence of diabetes, incidence and severity of upper gastrointestinal (UGIS), lower gastrointestinal (LGIS), and urinary symptoms were recorded from files. Correlation and logistic regression analysis was used to determine the impact of diabetes, age, chemotherapy, paraaortic irradiation on toxicities, and a prediction model was developed.

Results

The median age of 77 patients with endometrium cancer and 52 cervix cancer was 61 (range, 25-92) years, and 28 (21.7%) of them had diabetes. The median pelvic and tumor/tumor bed dose was 5040+247.65 cGy and 5040+222.91 cGy, respectively. Age and Gr 0 UGIS toxicity were significantly related (p=0.047). LGIS Gr 0 toxicity was found to be significantly higher in patients with diabetes (p=0.045). Gr 0 and 2 UGIS toxicities were both found to be significantly correlated with paraaortic irradiation (both p<0.001). Diabetes is also an important determinant on UGIS toxicity in patients who underwent paraaortic irradiation.

Conclusion

The correlation we found between toxicity and diabetes, concurrent chemotherapy or paraaortic radiation necessitates special care and risk stratification for patients with diabetes. Further prospective studies with long follow-up and larger patient groups are warranted.

Diabetes mellitus is a predictive factor for radiation pneumonitis after thoracic radiotherapy in patients with lung cancer

Purpose

We evaluated the effects of diabetes mellitus (DM) and DM-related serologic factors (HbA1c and fasting glucose) on the development of radiation pneumonitis in patients with lung cancer.

Methods

We retrospectively analyzed the clinical data of 123 patients with lung cancer treated with radiotherapy. Radiation pneumonitis was scored according to the toxicity criteria of the Radiation Therapy Oncology Group. We used binary logistic regression analysis to find significant predictive factors for the development of grade ≥3 radiation pneumonitis.

Results

On univariable analysis, V20, mean lung dose, DM, HbA1c, and fasting glucose level were significantly associated with the development of grade ≥3 radiation pneumonitis. On multivariable analysis, V20, mean lung dose, DM, HbA1c, and fasting glucose level remained significant predictive factors for grade ≥3 radiation pneumonitis. The incidence of grade ≥3 radiation pneumonitis was 44.4% in patients with DM and 20.7% in patients without DM. The incidence of grade ≥3 radiation pneumonitis was 12.7% for HbA1c level ≤6.15% and 41.5% for HbA1c level >6.15%. The incidence of grade ≥3 radiation pneumonitis was 17.2% for fasting glucose level ≤121 mg/dL and 35.5% for fasting glucose level >121 mg/dL.

Conclusion

DM, HbA1c, and fasting glucose level are significant predictive factors for the development of grade ≥3 radiation pneumonitis in patients with lung cancer. Patients with DM, patients who have HbA1c >6.15%, and patients who have fasting glucose >121 mg/dL should be treated with greater caution.

Diabetes and Lung Disease: A Neglected Relationship

BACKGROUND

Diabetes mellitus is a systemic disorder associated with inflammation and oxidative stress which may target many organs such as the kidney, retina, and the vascular system. The pathophysiology, mechanisms, and consequences of diabetes on these organs have been studied widely. However, no work has been done on the concept of the lung as a target organ for diabetes and its implications for lung diseases.

AIM

In this review, we aimed to investigate the effects of diabetes and hypoglycemic agent on lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, pulmonary hypertension, and lung cancer. We also reviewed the potential mechanisms by which these effects may affect lung disease patients.

RESULTS

Our results suggest that diabetes can affect the severity and clinical course of several lung diseases.

CONCLUSIONS

Although the diabetes-lung association is epidemiologically and clinically well-established, especially in asthma, the underlying mechanism and pathophysiology are not been fully understood. Several mechanisms have been suggested, mainly associated with the pro-inflammatory and proliferative properties of diabetes, but also in relation to micro- and macrovascular effects of diabetes on the pulmonary vasculature. Also, hypoglycemic drugs may influence lung diseases in different ways. For example, metformin was considered a potential therapeutic agent in lung diseases, while insulin was shown to exacerbate lung diseases; this suggests that their effects extend beyond their hypoglycemic properties.

What is the impact of diabetes mellitus on radiation induced acute proctitis after radical radiotherapy for adenocarcinoma prostate? A prospective longitudinal study

Background

Long-term complications of diabetes include cardiovascular disease, retinopathy, nephropathy, and neuropathy. Diabetic patients with prostate cancer could be at a high risk of radiation-induced acute proctitis following radical radiotherapy. Our aims were to analyse the incidence, severity, and duration of radiation proctitis in diabetic patients treated by radical radiotherapy and combined androgen deprivation for prostate cancer.

Material and methods

On the bases of inclusion and exclusion criteria 716 patients with prostate cancer were retrospectively recruited. Patients were stratified into diabetic patients and non-diabetic patients. The incidence, severity, and duration of proctitis were the main outcomes. A polynomial ordered logistic regression was fitted to determine the influence of diabetes status, age, blood pressures medication, co-morbidities, Gleason score, PSA after treatment, and tumour stage on the grades of proctitis. Time to resolution per year was modelled as a negative binomial generalised linear model.

Results

The overall mean age of patients was 67.44 (SD 6.77) years with a follow-up time of 3.36 (SD 2.05) years. Data exploratory analysis suggested that the only highly significant explanatory variable was the presence or absence of diabetes. Polynomial ordered logistic regression, however, showed that the presence (or not) of diabetes remained as the only significant predictor (t = -2.74; p = 0.0059) of severity of proctitis. A negative binomial generalised linear model showed that both grade of proctitis (z = -17.178; p < 0.001), and diabetes (z = -5.92; p < 0.001), were highly significant predictors of time to resolution.

Conclusions

Diabetic patients were significantly more likely to have proctitis after radical radiation therapy for prostate cancer. Diabetes was significantly associated with an induced risk of radiation induced proctitis and also with deceleration of its resolution.