适形放疗晚期肺癌放射性食管炎相关因素分析

Analysis of factors predicting radiation esophagitis in the treatment of advanced lung cancer with three-dimensional conformal radiotherapy

目的分析Ⅲ~Ⅳ期非小细胞肺癌三维适形放射治疗中急性放射性食管损伤（AE）的发生率及其相关因素。方法选择2006年3月至2008年11月行三维适形放疗的晚期肺癌患者195例,男165例,女30例。其中79例患者行同步放化疗,中位等效生物剂量为72.0 Gy,观察AE的发生率,采用单因素和多因素变量分析方法,对选择的临床和剂量学因素进行与2级以上AE的相关性分析。结果 2级AE 38例（19.5%）,3级AE 25例（12.8%）。单变量分析显示,临床因素中疗前体重下降≥5%、同时化放疗、淋巴结分期、临床类型和后程超分割放疗与2级以上AE有相关性,剂量学指标中食管受照最大剂量、平均剂量、V20、V25、V30、V35、V40、V45、V50、V55、V60的差异均有统计学意义（P〈0.001）,同时放化疗和V55在Binary Logistic多因素分析中的差异有统计学意义。结论Ⅲ~Ⅳ期非小细胞肺癌三维适形放射治疗中,同时化放疗和V55是预测AE最有价值的指标。

Objective To report the incidence of acute radiation esophagitis（AE） and analyze the factors related to acute radiation esophagitis in the treatment of stage Ⅲ-Ⅳ non-small cell lung cancer with three dimensional conformal radiotherapy（3DCRT）.Methods 195 non-small cell lung cancer patients treated with 3DCRT between March 2006 and November 2008 were selected.They consisted of 165 men and 30 women.Seventy-nine of them were treated with concurrent chemotherapy（CCT）.The median biologic effective dose of radiotherapy was 72.0 Gy.The incidence rate of the AE was observed.The clinical and dosimetric factors associated with grade-2 or more severe AE were analyzed using univariate and multivariate logistic analysis.Results AE was observed in thirty-eight cases（19.5%） with grade-2 and twenty-five cases（12.8%） with grade-3.Univariate analysis showed that clinical factors,such as pretreatment weight loss≥5%,CCT,lymph node stage,and the use of late-course hyperfractionated radiotherapy were significantly associated with grade-2 and-3 AE.Dose volume parameters received by esophagus including maximal esophageal dose,mean esophageal dose,V20,V25,V30,V35,V40,V45,V50,V55,V60 were also associated with AE.Multivariate logistic analysis showed that CCT and V55 were statistically most significant factors of AE（P0.001）.Conclusion CCT and V55 were the most valuable predictors of grade 2 or more severe AE in the 3D-CRT treatment of stage Ⅲ-Ⅳ NSCLC.