中华放射医学与防护杂志

吕冬婕,王澜,韩春,等.局部晚期非小细胞肺癌同期放化疗所致急性食管损伤相关因素分析[J].中华放射医学与防护杂志,2010,30(2):185-188.LV Dong-jie,WANG Lan,HAN Chun,et al.Toxicity analysis for esophagus in locally advanced non-small cell lung cancer(NSCLC) treatment using three dimensional conformal radiotherapy combined with concurrent chemotherapy[J].Chin J Radiol Med Prot,2010,30(2):185-188

局部晚期非小细胞肺癌同期放化疗所致急性食管损伤相关因素分析

Toxicity analysis for esophagus in locally advanced non-small cell lung cancer(NSCLC) treatment using three dimensional conformal radiotherapy combined with concurrent chemotherapy

投稿时间：2009-05-18

DOI：

中文关键词: 肺肿瘤放射疗法适形放疗化学疗法放射性食管损伤

英文关键词:Lung neoplasm Conformal radiotherapy Chemotherapy Acute radiation esophagitis

基金项目:河北省普通高校强势特色学科课题(冀教高[2005]52号)

作者	单位	E-mail
吕冬婕	050011 石家庄,河北医科大学第四医院放疗科
王澜	050011 石家庄,河北医科大学第四医院放疗科
韩春	050011 石家庄,河北医科大学第四医院放疗科	hanchun2006@126.com
高超	050011 石家庄,河北医科大学第四医院放疗科
李晓宁	050011 石家庄,河北医科大学第四医院放疗科

摘要点击次数: 4338

全文下载次数: 2255

中文摘要:

目的观察三维适形放疗联合NP方案同期化疗治疗Ⅲ期非小细胞肺癌的急性放射性食管炎发生情况,并对相关因素进行分析,以求得到合理的预测性指标。方法 52例III期非小细胞肺癌患者接受三维适形放疗及NP方案同期化疗,放疗处方剂量60 Gy,1.8～2 Gy/次,5次/周,共30～34次,于放疗开始的第1周、第5周给予同期化疗,观察急性放射性食管炎发生情况并进行单因素、多因素及ROC曲线分析。结果食管炎总发生率为84.6％(44/52),其中0级8例(15.3％),1级16例(30.8％),2级12例(23.1％),3级16例(30.8％),无4级发生。相关因素分析及Binary Logistic单因素分析显示,食管接受的平均剂量(MED)、LETT₄₀、LETT₄₅、LETT₅₀、LETT₅₅、LETT₆₀、V₄₀、V₄₅、V₅₀、V₅₅、V₆₀均与放射性食管炎具有较好的相关性,能预测急性放射性食管炎的发生(χ²=7.355～8.690,P＜0.05);多因素分析结果提示,食管V₅₅是预测放射性食管炎最有价值的指标。ROC曲线(受试者工作特征曲线)分析结果显示,曲线下面积为0.725(P＝0.006),曲线界值为V₅₅=26％,食管V₅₅＞26％组与≤26％组2级及以上放射性食管炎的发生率分别为67.7％(21/31)和33.3％(7/21)。结论对局部晚期NSCLC进行三维适形放疗及同期化疗,可出现较严重的放射性食管炎,食管MED、LETT₄₀、LETT₄₅、LETT₅₀、LETT₅₅、LETT₆₀、V₄₀、V₄₅、V₅₀、V₅₅、V₆₀可以较好地预测放射性食管炎的发生,V₅₅可能是最有价值的预测性指标。当V₅₅＞26％时,2、3级急性放射性食管炎的发生率可能会明显增加。

英文摘要:

Objective To investigate the radiation toxicity for esophagus in stage III NSCLC treatment using three dimensional conformal radiotherapy(3D CRT) combined with concurrent chemotherapy, and to obtain the relevant factors that can be regareded as predictors to complications of esophagus. Methods From Sep 2006 to Dec 2008, 52 patients with stage III NSCLC received 3D CRT plus concurrent chemotherapy of navelbine+cisplatin(NP) with prescription of 60 Gy/30 fractions, and chemotherapy at 1 and 5 week. Univariate and multivariate analysis and ROC(receiver operating characteristic curves) were performed to assess theassociation ofradiation-induced esophagitis and the correlated factors. Results Of all the patients, 84.6％(44/52) developed radiation esophagitis including grade 1 for 16 patients, grade 2 for 12 patients and grade 3 for 16 patients, without grade 4 developed. The correlative factors comprised of mean esophagus dose(MED), the LETT₄₀, LETT₄₅, LETT₅₀, LETT₅₅, LETT₆₀, V₄₀, V₄₅, V₅₀, V₅₅ and V₆₀ of esophagus according to Spearman correlative analysis, and all the 11 factors could predict radiation esophagitis according to univariate analysis(χ²=7.355-8.690, P＜0.05). Only V₅₅ was found independently associated with esophagitis according to multivariate analysis. ROC analysis indicated that the cut-off point of the curve was 26% with the area under ROC curve of 0.725(P=0.006). For the patients with esophageal V₅₅＞26%, 21 of 31(67.7%) developed 2 or 3 grade radiation esophagitis, while for the patients with V₅₅≤26%, only 7 of 21(33.3%) developed severe esophagitis. Conclusions 3D CRT combined with concurrent chemotherapy for patients with stage III NSCLC may develop severe radiation esophagitis. Dosimetric parameters (MED, LETT₄₀, LETT₄₅, LETT₅₀, LETT₅₅, LETT₆₀, V₄₀, V₄₅, V₅₀, V₅₅ and V₆₀) were important to predict the radiation-induced esophagitis. According to multivariate analysis, V₅₅ may be the most valuable predictor. When the value of V₅₅ excluded 26%, the probability of esophagitis of grade 2 and 3 may increase notably.

HTML 查看全文查看/发表评论下载PDF阅读器

关闭