非小细胞肺癌三维适形放射治疗对食管损伤的临床和剂量学预测因素

The Predictors of Radiation-induced Esophageal Toxicity in Patients with Non-small Cell Lung Cancer Treated with Three-dimensional Conformal Radiotherapy

目的:分析非小细胞肺癌(NSCLC)在三维适形放射治疗(3D-CRT)时,放射所致3～5级(RTOG标准)食管损伤的临床和剂量学的预测因素。方法:对连续的208例三维适形放射治疗的非小细胞肺癌患者,男146例,女62例,中位年龄64岁(35～87岁)进行了回顾性分析。分析对象为:性别,年龄,一般状态,序贯化疗,同期化疗,隆突下淋巴结,治疗前体重下降,整个食管平均剂量,最大剂量点,食管接受>55Gy的百分比。依据RTOG标准,分析早期和晚期3～5级食管损伤。结果:208例中,25例(12%)发展为早期和晚期3～5级的食管损伤,其中9例包括早期和晚期损伤,2例死于食管穿孔。同期化疗和食管的最大剂量点≥60Gy与3～5级食管损伤明显有关。其中同期化疗的54例(26%),25例(46%)有3～5级食管损伤。最大剂量点小于60Gy的患者,无3～5级食管损伤(P<0.01)发生。结论:在NSCLC三维适形放疗时,放化疗同期进行和最大剂量点≥60Gy明显地与3～5级食管损伤有关。

Objective： To analyze the clinical and dosimetric predictive factors for radiationinduced esophageal injury in patients with non-small cell lung cancer （NSCLC） during threedimensional conformal radiotherapy （3D-CRT）. Methods： A total of 208 consecutive patients（146 men and 62 women） with NSCLC, treated with 3D-CRT, were analyzed retrospectively. The median age of the patients was 64 （range 35-87）. The clinical and treatment parameters including gender, age, performance status, sequential chemotherapy, concurrent chemotherapy, presence of carinal or subcarinal lymph nodes, pretreatment weight loss, mean dose to the entire esophagus, maximal point dose to the esophagus, and percentage of volume of esophagus receiving〉55Gy were studied. Clinical and dosimetric factors for radiation-induced acute and late grade 3-5 esophageal injury were analysed, according to Radiation Therapy Oncology Group （RTOG） criteria. Results： Twenty-five （12%） of the 208 patients developed acute or late grade 3-5 esophageal injury, among which, 9 patients had both acute and late grade 3-5 esophageal injury and 2 died of late esophageal perforation. Concurrent chemotherapy and maximal point dose to the esophagus ≥60Gy were significantly associated with the esophageal injury. Fifty-four （26%） of the 208 patients received concurrent chemotherapy, among which 25 （46%） developed grade 3-5 esophageal injury （P〈0.01）. No grade 3-5 esophageal injury occurred in patients who received a maximal point dose to the esophagus 〈60Gy （P〈0.01）. Conclusion： Concurrent chemotherapy and the maximal esophageal point dose≥60Gy significantly related to the risk of grade 3-5 esophageal injury in patients with NSCLC treated with 3D-CRT