| 杜峰,王强,王玮,等.胸段食管癌放疗后放射性肺炎相关因素分析[J].中华放射医学与防护杂志,2020,40(11):832-839.Du Feng,Wang Qiang,Wang Wei,et al.Analysis of related factors of radiation pneumonitis after radiotherapy for thoracic segment esophageal cancer[J].Chin J Radiol Med Prot,2020,40(11):832-839 |
| 胸段食管癌放疗后放射性肺炎相关因素分析 |
| Analysis of related factors of radiation pneumonitis after radiotherapy for thoracic segment esophageal cancer |
| 投稿时间：2020-07-04 |
| DOI：10.3760/cma.j.issn.0254-5098.2020.11.004 |
| 中文关键词: 食管癌 放疗技术 放射性肺炎 危险因素 |
| 英文关键词:Esophageal cancer Radiotherapy technology Radiation pneumonia Risk factor |
| 基金项目:国家重点研发计划项目（2016YFC0904700）；国家自然基金面上项目（81773287）；山东省重点研发计划项目（2016GSF201093） |
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| 中文摘要: |
| 目的 探讨胸段食管癌患者临床特征、照射技术及肺剂量体积参数等因素对放疗后放射性肺炎（RP）的影响，为食管癌放疗方案的制定提供参考。方法 回顾性分析山东省肿瘤防治研究院山东省肿瘤医院山东第一医科大学山东省医学科学院2014年6月至2019年6月247例胸段食管癌患者放疗后RP的发生情况，对患者临床特征、照射技术及肺剂量学参数进行单因素和多因素分析，采用受试者工作特征（ROC）曲线下的面积（AUC）分别验证≥1级、≥2级、≥3级RP的诊断效能。结果 全组患者中≥1级RP 118例（47.8%），≥2级RP 54例（21.9%），≥3级RP 17例（6.9%）。单因素分析结果显示，双肺V5~V40、平均肺剂量（MLD）均与≥1级RP（Z=-5.802~-4.306，P<0.05）和≥2级、≥3级RP（F=0.057~11.616、0.087~3.392，P<0.05）发生有关，GTV体积、PTV体积、GTV/肺体积（%）、PTV/肺体积（%）均与≥1级RP（Z=-3.377~-2.041，P<0.05）和≥2级RP（F=3.600~9.801，P<0.05）发生有关；吸烟指数>400与≥3级RP明显相关（χ2=13.295，P<0.05），慢性阻塞性肺病（COPD）与≥1级RP者明显相关（χ2=9.146，P<0.05），而不同的照射技术、化疗因素、放疗剂量以及食管癌分期、位置均与RP无显著相关。多因素分析结果显示，双肺V5和V40为≥1级RP的独立危险因素，AUC最佳临界值分别为55.74%和4.13%；MLD为≥2级RP的独立危险因素，最佳临界值为11.91 Gy；双肺V5为≥3级RP的独立危险因素，最佳临界值为57.60%。吸烟指数>400为≥3级RP的独立危险因素（Wald＝5.964，P<0.05），COPD为≥1级RP的独立危险因素（Wald＝6.110，P<0.05）。结论 胸段食管癌放疗后RP的发生率较低，双肺V5、V40、MLD等剂量学参数及吸烟程度和COPD等临床特征与相应等级的RP的发生密切相关，实施食管癌放疗时应重点关注。 |
| 英文摘要: |
| Objective To investigate the effects of clinical characteristics, irradiation techniques and dose-volume parameters on radiation pneumonitis(RP) in thoracic segment esophageal cancer patients, so as to provide reference for the formulation of radiotherapy protocol for thoracic esophageal cancer. Methods The incidence of RP in 247 patients with thoracic segment esophageal cancer from June 2014 to June 2019 was analyzed retrospectively, then univariate and multivariate analyses were performed on the clinical characteristics, radiation techniques and lung dosimetry parameters of these patients. The area under receiver operating characteristic (ROC) curve was used to verify the diagnostic efficacy of RP≥grade 1, ≥grade 2 and ≥grade 3. Results There were 118 cases (47.8%)with RP≥grade 1, 54 cases (21.9%)with RP≥grade 2,17 cases (6.9%)with RP≥grade 3. The result of univariate analysis showed that lung V5-V40 and MLD were both related to the occurrence of RP≥grade 1(Z=-5.802 to -4.306,P<0.05). ≥grade 2,and≥grade 3, respectively(F=0.057 to 11.616、0.087 to 3.392,P<0.05). GTV volume, PTV volume, GTV/lung volume(%) and PTV/lung volume(%) were related to RP≥grade 1(Z=-3.377 to -2.041,P<0.05)and RP≥grade 2(F=3.600 to 9.801,P<0.05). Smoking index >400 was significantly correlated with RP≥grade 3(χ2=13.295, P<0.05), and chronic obstructive pulmonary disease (COPD) was significantly correlated with RP≥grade 1(χ2=9.146, P<0.05). However, there was no significant correlation between RP and different irradiation techniques, chemotherapy factors, radiotherapy dose, esophageal cancer stage and cancer location.The result of multivariate analysis showed that V5 and V40 were independent risk factors of RP≥grade 1(AUC 55.74%、4.13%)、MLD was independent risk factors of RP≥grade 2 (AUC 11.91 Gy), and V5 was independent risk factors of RP≥grade 3(AUC 57.60%). The smoking index>400 was the independent risk factor of RP≥grade 3 (Wald＝5.964,P<0.05), and COPD was the independent risk factor of RP≥1 grade (Wald＝6.110, P<0.05). Conclusions The incidence of RP is low after radiotherapy for thoracic segment esophageal cancer. The dosimetric parameters such as lung V5, V40, MLD, smoking degree, COPD and other clinical characteristics are closely related to the occurrence of RP of corresponding grades. |
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