In a small prospective study conducted in China, researchers evaluated the use of Epigallocatechin-3-gallate (EGCG), a flavonoid present abundantly in the most popular drink – Green tea, in esophageal cancer patients with radiation treatment induced swallowing difficulties (esophagitis). They found that EGCG may be beneficial in reducing radiation treatment induced swallowing difficulties in these patients treated with concurrent chemoradiation or radiation treatment without negatively impacting the efficacy of these therapies. Green tea, usually taken as part of a healthy diet/nutrition, may also be used to reduce chemo-induced side-effects in esophageal cancer.
Esophageal Cancer and Radiation Treatment Induced Esophagitis
Esophageal cancer is estimated to be the seventh common cause of cancer worldwide and accounts for 5.3 % of cancer deaths globally (GLOBOCAN, 2018). Radiation and chemoradiation (chemotherapy along with radiation) are the most commonly used treatments for esophageal cancer. However, these treatments are associated with several serious side-effects including acute radiation induced esophagitis (ARIE). Esophagitis is the inflammation of the esophagus, a muscular hollow tube which connects the throat with the stomach. The onset of acute radiation-induced esophagitis (ARIE) generally happens within 3 months post radiotherapy and can often lead to serious swallowing problems / difficulties. Hence, different strategies for relieving radiation treatment-induced swallowing problems are being explored as it is crucial to the oncologists for the proper management of impacted patients.
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Study on Impact of Green Tea active EGCG on Radiation Treatment-Induced Esophagitis in Esophageal Cancer
Epigallocatechin-3-gallate (EGCG) is a flavonoid with strong antioxidant and anti-inflammatory properties and is also used for reducing the risk of specific cancers. It is one of the most abundant ingredients present in green tea and is also found in white, oolong, and black teas. A phase II clinical study was recently conducted by the researchers at Shandong Cancer Hospital and Institute in China, to evaluate the effect of green tea component EGCG (usually taken as part of a healthy diet) on chemoradiation/radiation treatment induced esophagitis (swallowing difficulties) in esophageal cancer patients who were admitted between 2014 to 2016 (Xiaoling Li et al, Journal of Medicinal Food, 2019). A total of 51 patients were included in the study,out of which 22 patients received concurrent chemoradiation therapy (14 patients were treated with docetaxel + cisplatin followed by radiotherapy and 8 with fluorouracil + cisplatin followed by radiotherapy) and 29 patients received radiation therapy and were monitored weekly for acute radiation induced esophagitis (ARIE) / swallowing difficulties. The severity of ARIE was determined using Radiation Therapy Oncology Group (RTOG) Score. Patients with grade 1 RTOG score were supplemented with 440 µM EGCG and the RTOG scores after the use of EGCG were compared with the baseline scores (when treated with radiation or chemoradiation).
The key findings of the study are listed below (Xiaoling Li et al, Journal of Medicinal Food, 2019):
- The comparison of the RTOG scores in the first, second, third, fourth, fifth, and sixth week after EGCG (green tea active) supplementation and the first and second week after radiotherapy indicated a significant reduction in swallowing difficulties / acute radiation induced esophagitis (ARIE).
- 44 out of 51 patients showed a clinical response, with the response rate at 86.3%, including 10 Complete Response and 34 Partial Response.
- After 1, 2, and 3 years, the overall survival rate was found to be 74.5%, 58%, and 40.5% respectively.
In Conclusion : Green Tea (EGCG) reduces Swallowing Difficulties in Esophageal Cancer
Based on these key findings, the researchers concluded that EGCG supplementation reduces swallowing difficulties/esophagitis without negatively impacting the efficacy of radiation treatment. Drinking Green tea as part of daily diet would be hence helpful in reducing the swallowing difficulties, thereby improving the quality of life of esophageal cancer patients. Such clinical studies, though conducted in a small set of patients, are promising and help in identifying new strategies to manage chemotherapy or radiation therapy induced side-effects. However, the effects of EGCG in reducing radiation treatment induced esophagitis should be further evaluated and confirmed in a large randomized clinical study with a control group (control group was missing in the current study) before implementing it as a treatment protocol.
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