OBJECTIVE To observe the clinical efficacy of Xuefu Zhuyu Decoction (XFZY) in the prevention and treatment of radiation-induced lung fibrosis (RILF) in esophageal cancer patients with blood stasis type underwent concurrent chemoradiotherapy(CRT).

METHODS A total of 130 esophageal cancer patients with blood stasis type who treated with concurrent CRT were randomly divided into an experimental group and a control group, with 65 cases in each group. No patients dropped out during the study period. Patients in both groups received CRT and standardized symptomatic treatment was given according to the condition if radiation-induced lung injury occurred during treatment. On the basis of the treatment of the control group, the patients in the experimental group received XFZY from the beginning day until 30 days after the completion of CRT. The TCM syndrome score of the two groups were compared before and after treatment. The incidence of acute radiation pneumonia (RP) and chronic RILF and changes in pulmonary function indicators forced expiratory volume in the first second as a percentage of predicted value (FEV1%pred), forced vital capacity (FVC), FVC as a percentage of predicted value (FVC%pred), FEV1/FVC ratio, and carbon monoxide diffusing capacity as a percentage of predicted value (DLCO%pred) and serum cytokine levels interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF), and transforming growth factor β1 (TGF-β1) were compared at 6 months and 12 months after the completion of CRT. The occurrence of adverse reaction during treatment was recorded.

RESULTS The total score of TCM syndrome of the two groups was significantly improved and the experimental group was better than that of the control group (P < 0.01) after treatment. The efficacy of TCM syndrome was better in the experimental group than that of the control group (P < 0.01). There was no statistically significant difference in the incidence rate of acute RP between the two groups (P > 0.05) at 6 months after the completion of CRT. The levels of lung function indicators FEV1%pred, FVC%pred, and DLCO%pred in the experimental group were higher than those in the control group (P < 0.05), and the levels of various cytokines in the experimental group were lower than those in the control group (P < 0.05). The incidence rate of chronic RILF in the experimental group was significantly lower than that of the control group (P < 0.05) at 12 months after the completion of CRT. The DLCO%pred level in the experimental group was higher than that in the control group (P < 0.01), and the levels of cytokines HIF-1α, VEGF, and TGF-β1 were lower than those in the control group (P < 0.05, P < 0.01). There was no serious adverse event observed in either group of patients during the treatment.

CONCLUSION XFZY can effectively prevent and treat RILF in esophageal cancer patients with blood stasis type underwent CRT, reducing the loss to lung function caused by radiotherapy, and its mechanism may be related to downregulating the levels of cytokines of HIF-1α, VEGF, and TGF-β1.