The effect of the wound healing properties of glutamine on skin toxicities and esophagitis in breast cancer radiotherapy

Abstract

Objective: Acute toxicities of breast cancer radiotherapy are weakness, skin reactions and esophagitis. Glutamine is an essential amino acid that forms the basic energy source of the immune system cells andthe intestine inner surface cells and plays an essential role in the delivery of acid-base balance and the nerve transmission. In our study, we aimed to evaluate the effect of the wound healing properties of glutamine on skin toxicities and esophagitis. Materials and Methods: Fifty six patients were included in the study. The results of 28 patients who used 30 g(10g/8h) Glutamine during radiotherapy and 28 patients without glutamine usage were evaluated. 40-60 GyRT was given with a single fraction of 2-2.66 Gy per dayin five fractions weekly. Skin reactions and esophagitis status of the patients were evaluated weekly. Toxicities were recorded according to Radiation Toxicity Evaluation Criteria (RTOG). Results: The mean age was 53 years (29-86). 42 patientshad underwent breast-conserving surgery and 14 patients had underwent modified radical mastectomy. 39 patients had stage 2,17 had stage 3 dissease. Dysphagia had developed in 23 patients (42.6%). Grade 1 dysphagia was detected in 20 patients and grade 2 dysphagia was detected in 3 patients. Skin reaction had developed in 38 patients (70.4%). 17 of these had grade 1, 20 had grade 2 and 1 had grade 3 skin reaction.Dysphagia (P <0.001) and skin reaction (P = 0.014) were statistically significant lower in the group receiving glutamine. In premenopausal patients, significantly more dysphagia (p: 0.003) and skin reactions (p: 0.018) were observed than postmenopausal patients. Skin reaction and dysphagia were observed less in the group that received hypofractioned RT. Dysphagia was observed more in the MRM receiving group according to the surgery type. It was observed that there was no effect of stage, age, T-N stage, tumor side, pathological type on skin reaction and dysphagia. Conclusion: The use of glutamine to reduce side effects during breast cancer radiotherapy is not a standard procedure. However, the use of glutamine in the treatment of dysphagia and skin reactions during breast radiotherapy may be useful in reducing the severity of the toxicities by it's wound healing effect.