| 田丹丹,王玉祥,邱嵘,等.局部晚期非小细胞肺癌三维适形放疗所致放射性食管炎的相关因素[J].中华放射医学与防护杂志,2014,34(9):678-682.,et al.Radiation-induced esophagitis in local advanced non-small cell lung cancer after three-dimensional conformal radiotherapy[J].Chin J Radiol Med Prot,2014,34(9):678-682 |
| 局部晚期非小细胞肺癌三维适形放疗所致放射性食管炎的相关因素 |
| Radiation-induced esophagitis in local advanced non-small cell lung cancer after three-dimensional conformal radiotherapy |
| 投稿时间：2013-12-25 |
| DOI：10.3760/cma.j.issn.0254-5098.2014.09.009 |
| 中文关键词: 非小细胞肺癌 局部晚期 三维适形放疗 放射性食管炎 |
| 英文关键词:Non-small cell lung cancer Local advanced Three dimensional conformal radiotherapy Radiation-induced 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） |
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| 中文摘要: |
| 目的 观察局部晚期非小细胞肺癌（NSCLC）三维适形放疗所致放射性食管炎的相关影响因素。方法 回顾性分析2001年1月至2008年12月期间接受放疗的局部晚期非小细胞肺癌203例，其中男性163例，女性40例，中位年龄63岁；Ⅲa期79例，Ⅲb期124例；中位等效处方剂量62 Gy（范围50~78 Gy），其中，单纯放疗74例，序贯放化疗45例，同期放化疗87例。急性放射性食管炎采用美国肿瘤放射治疗协作组（RTOG）标准，剂量体积直方图（DVH）评估物理参数。对与放射性食管炎相关的临床因素及物理参数进行相关性分析。结果 203例局部晚期NSCLC放疗后，发生1级急性放射性食管炎者47例，2级37例，3级4例，≥2级放射性食管炎发生率为20.2%（41/203）。单因素分析表明，年龄、化疗（单纯放疗/序贯放化疗/同期放化疗）、GTV、PTV、PTV和肺的平均剂量、食管最大剂量和平均剂量、食管V40、V45、V50、V55、V60、全周食管接受剂量>45 Gy的食管长度（LETT45）和LETT50与≥2级放射性食管炎相关（r=-0.162~0.235，P<0.05）；而性别、肿瘤位置、吸烟与否、T、N分期、临床分期、放疗剂量、分割方式、GTV平均剂量、LETT55、LETT60与≥2级放射性食管炎无明显相关（r=-0.106~0.122，P＞0.05）。将以上所有因素进行多因素分析，结果仅化疗和食管V45是≥2级放射性食管炎发生的独立危险因素（Wald=4.626和9.882，P<0.05）。结论 局部晚期非小细胞肺癌同期放化疗明显增加放射性食管炎；DVH中物理学参数可用于预测和评价放射性食管炎的发生，其中食管V45可能是最有价值的预测指标。 |
| 英文摘要: |
| Objective To explore radiation-induced esophagitis and its related factors in the patients with local advanced non-small cell lung cancer (NSCLC) which were treated with three-dimensional conformal radiation therapy (3D-CRT).Methods From January 2001 to December 2008, 203 patients who suffered from stage Ⅲ NSCLC were achieved, including 163 males and 40 females, with a median age of 63 years old, while 79 cases were in stage Ⅲa and 124 in stage Ⅲb. The equivalent median dose of tumor was 62 Gy(range of 50-78 Gy). Among them, 74 cases were administered with radiotherapy alone, 45 with sequential radiotherapy and chemotherapy, 87 cases with concurrent radiochemotherapy. Radiation esophagitis was evaluated with RTOG standard. The dosimetric parameters was estimated from dose volume histogrma (DVH). The clinical and dosimetric parameters of radiation esophagitis were evaluated by spearman correlatived univariate and Logistic multivariable analysis.Results After radiotherapy, out of 203 patients, 87 had acute radiation esophagitis(RE), 47 in grade 1, 37 in grade 2, and 3 in grade 3 RE. According to spearman correlatived analysis, the correlatived factors included ages, chemotherapy, GTV, PTV, the mean doses of PTV and lung, the max and mean dose of esophagus, V40,V45,V50,V55,V60, length of esophagus(total circumference)treated with 45 Gy (LETT45), and LETT50 (r=-0.162-0.235,P<0.05). All the 14 factors had good correlation with RE in univariate analysis.But for other factors,such as gender, site of tumor, smoking, T, N, clinical stage, equivalent dose of tumor, style of radiation, the mean dose of GTV, LETT55 and LETT60, there were not correlation with ≥grade 2 RE with univariate analysis(r=-0.106-0.122, P＞0.05). There were 21 factors, such as gender, age, smoking, clinical stage, site of tumor, chemotherapy, GTV, PTV, mean dose of PTV and lung, max and mean dose of esophagus, V40-V60of esophagus, LETT45-60, incorporated into multivariable analysis, only chemotherapy and V45 of esophagus were independent predicted factors(Wald=4.626, 9.882, P<0.05). Conclusions In local advanced NSCLC after 3D-CRT, chemotherapy(especially concurrent radiochemotherapy) could increase radiation-induced esophagitis. The parameter of DVH could also be used to predict radiation-induced esophagitis, V45 of esophagus may be the most valuable predictor. |
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