Oral Epigallocatechin-3-Gallate Treats Acute Radiation-Induced Esophagitis In Patients With Esophageal Cancer Receiving Chemoradiation Therapy/Radiation Therapy

Patients with esophageal cancer receiving definitive chemo-radiation therapy/radiation therapy often develop acute radiation-induced esophagitis (ARIE) that may interference with quality of life and lead to unplanned treatment interruptions. Our previous trials preliminarily showed that EGCG could be a promising strategy in the treatment of ARIE when esophagus received low dose radiation (mean dose, 14.9Gy) in lung cancer. We hypothesize that EGCG is safe and effective in treating ARIE in esophageal cancer patients with higher mean esophagus dose. All the patients underwent three dimensional conformal or intensity modulation radiated therapy (total dose, 50.4-60Gy). Eligible patients were also required to have met the following criteria: age≥18 years; ECOG PS 0-1; no prior radiation to the thorax; concurrent chemo-radiotherapy or radiotherapy only. EGCG was administrated once ARIE appeared. EGCG was given with the concentration of 440μmol/L during radiotherapy and additionally 2 weeks after radiotherapy. RTOG score, dysphasia and pain related to esophagitis were recorded every week. Thirty-seven patients with stage IIB and III esophageal cancer were enrolled in this study. 81.1% patients received concurrent chemotherapy. Two cases stopped the radiotherapy because of arrest of bone marrow or infection, thus EGCG treatment was also stopped. Other 4 cases also stopped EGCG treatment because of their personal reasons. The median dose of the appearance of ARIE was 28Gy (range, 12–48 Gy). In comparison to the original, the RTOG score in the 1st, 2nd, 3rd, 4th, 5th week after EGCG prescription and the 1st, 2nd week after radiotherapy decreased significantly (P = 0.161, 0.012, 0.022, 0.042, 0.076, 0.000, 0.000, respectively). The pain score of each week was significantly lower than the baseline (P = 0.000, 0.000, 0.000, 0.000, 0.012, 0.000, 0.000, respectively). The EGCG solution was generally well-tolerated, but most patients complained of its nauseating taste. Complete response after chemoradiotherapy/radiotherapy for esophageal cancer obtained in 4 patients, partial response in thirteen, stable disease in thirteen, and progression in one. This study confirmed that the oral administration of EGCG is an effective and safe method to deal with ARIE, even when the esophagus received more than 50.4 Gy radiation. A phase III randomized controlled trial is expected to further corroborate the consequence of EGCG in ARIE treatment in patients with esophageal cancer.