食管癌调强放疗并发放射性肺损伤的危险因素分析

Risk Factors Analysis of Radioactive Lung Injury Induced by Intensity-modulated Radiotherapy in Patients with Esophageal Cancer

目的:分析食管癌调强放疗并发放射性肺损伤的危险因素。方法:以2015年2月-2018年2月于青海医学院附属医院接受调强放疗的食管癌患者100例为研究对象。分别收集患者年龄、性别、吸烟史、同步化疗情况、卡氏评分、肿瘤分期等资料以及放射剂量学因素V5、V10、V20、V30、Dmean情况,并采用单因素和多因素Logistic回归分析分析食管癌调强放疗并发放射性肺损伤的危险因素。结果:100例患者中发生放射性肺损伤人数为27例,发生率为27.00%。其中1级20例,2级7例。经单因素分析可得:食管癌调强放疗并发放射性肺损伤与卡氏评分、V5、V10、V20、V30以及Dmean有关(P<0.05);与性别、年龄、吸烟史、同步化疗、肿瘤分期无关(P>0.05)。经多因素Logistic回归分析可得:卡氏评分<80分、V5≥60%、V10≥40%、V20≥25%、V30≥20%、Dmean≥10%均是食管癌调强放疗患者并发放射性肺损伤的独立危险因素(P<0.05)。结论:食管癌调强放疗并发放射性肺损伤的发生率较高,且与卡氏评分以及放射剂量学因素V5、V10、V20、V30、Dmean密切相关。临床工作中可通过控制肺组织的照射剂量,减少放射性肺损伤发生风险。

Objective: To analyze the risk factors of radioactive lung injury induced by intensity-modulated radiotherapy in patients with esophageal cancer. Methods: A total of 100 patients with esophageal cancer, who received intensity-modulated radiotherapy in the Affiliated Hospital of Qinghai Medical College from February 2015 to February 2018, were selected as research subjects.The data such as age, sex, smoking history, synchronous chemotherapy, karnofsky, tumor stage and radiation dosimetry factors V5, V10, V20, V30, and Dmean situation were collected. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of radioactive lung injury induced by intensity-modulated radiotherapy in patients with esophageal cancer. Results: Among the 100 patients, there were 27 cases of radioactive lung injury, the incidence was 27.00%, in which, there were 20 cases at grade 1 and 7 cases at grade 2. Univariate analysis showed that radioactive lung injury induced by intensity-modulated radiotherapy in patients with esophageal cance were related to karnofsk, V5, V10, V20, V30 and Dmean (P <0.05), but not related to sex, age, smoking history, synchronous chemotherapy and tumor stage (P>0.05). Multivariate logistic regression analysis showed that karnofsk <80 scores, V5>60%, V10>40%, V20>25%, V30>20%, and Dmean >10% were the independent risk factors of radioactive lung injury induced by intensity-modulated radiotherap in patients with esophageal cancer (P <0.05). Conclusion: The incidence of radioactive lung injury induced by intensity-modulated radiotherap in patients with esophageal cancer is higher. And it is closely related to karnofsk and radiation dosimetry factors such as V5, V10, V20, V30 and Dmean. In clinical work, the risk of radioactive lung injury can be reduced by controlling the dose of lung tissue.