三维适形放疗非小细胞肺癌所致食管损伤相关因素分析

Radiation-induced esophageal injury in three-dimensional conformal radiotherapy for nonsmall cell lung cancer

目的 分析三维适形放疗非小细胞肺癌 (NSCLC)患者放射性食管损伤的临床物理因素 ,为优化NSCLC三维适形放疗计划提供参考标准。方法 87例未经手术治疗的NSCLC患者接受三维适形放疗。回顾性分析所有患者三维适形计划及临床资料 ,评价食管损伤并对相关因素进行单因素、多因素分析。结果 87例中发生急性食管炎 38例 ,其中 1级 2 4例 ,2级 8例 ,3级 5例 ,4级 1例。晚期食管反应 9例 ,其中 1级 2例 ,2级 3例 ,3级 4例。食管所受最小剂量平均值为 4 0 5cGy,最大剂量均值为 6 792cGy ,平均剂量平均值为 35 5 7cGy。与急性食管炎相关的因素有食管V50 、食管V60 、化疗及肺癌临床分型 ;与晚期食管损伤相关的因素有食管所受最大剂量、食管NTCP值。Logistic多元回归结果显示 ,急性放射性食管炎发生的独立影响因素为化疗、食管V50 、食管V60 (OR值分别为 3.5 32、1.0 89、0 .94 0 )。急性放射性食管炎、晚期食管反应对生存率影响不明显。结论 NSCLC三维适形放疗中是否接受化疗以及食管V50 、食管V60 是引起急性放射性食管炎的主要原因 ,建议中央型NSCLC制定三维适形放疗计划时考虑以上因素。

Objective To evaluate the clinical factors and treatment para meters related to the acute and late esophageal toxicities in non-small cell lung can ce r (NSCLC) treated with three-dimensional conformal radiotherapy(3DCRT). Methods From August 2000 to December 2002, 87 such patients were reviewed retrospec tively with clinical factors and treatment parameters in relation to the acute and late esophageal toxicities. Logistic regression method was used to test the ir relativities. Results According to the RTOG criteria, acute esophageal toxic ity was observed in 38 patients (43.6%),with 24 in grade I, 8 grade II,5 grade I II and 1 grade IV, while late toxicity was observed in 9 patients (10.3%), with 1 in grade II , 2 grade III and 3 grade IV. The average minimal, maximal and me an esophagus absorbed doses were 405?cGy, 6792?cGy and 3557?cGy, respectively . Chem otherapy, percentage of esophageal volume absorbing dose >50?Gy (V 50), V 60 and tu mor location were significantly correlated with acute esophageal toxicity, as th e maximal dose to the esophagus and esophageal normal tissue complication probab ility were with late esophageal toxicity. Multilogistic regression analysis sho wed that chemotherapy (OR=3.532), V 50 (OR=1.809), V 60 (OR=0.940) wer e the indepe ndent factors for acute esophageal toxicity. Acute and late esophageal toxicitie s had no significant impact on survival. Conclusions Chemotherapy, V 50 and V 60 are significantly associated with the acute esophageal toxicity in NSCLC patie nts treated with 3DCRT. These factors should be given special consideration wh en planning the treatment for centrally located tumor.