中下段食管癌三维适形放疗并发放射性肺损伤的相关因素分析

Analysis on Correlated Factors of Complicated Radiation Pneumonitis after Three-Dimensional Conformal Radiotherapy in the Middle and Lower Esophageal Cancer

目的:探讨中下段食管癌患者行三维适形放疗(three-dimensional conformal radiotherapy,3DCRT)时的临床物理参数及患者的免疫学指标与发生放射性肺损伤的相关性。方法:收集46例行3DCRT的初治中下段食管癌患者的临床资料,分析年龄、性别、肿瘤直径、TNM分期、双肺体积、是否行同步化疗、放疗总量和布野方式等与发生放射性肺损伤的相关性;采用靶区等剂量曲线和剂量体积直方图(DVH)分析放射性肺损伤患者(RP组)3DCRT的靶区和肺组织剂量参数的变化;比较RP组和非RP组(未发生肺损伤患者)放疗后静脉血中淋巴细胞(LC)数、C反应蛋白(CRP)、T细胞亚群(CD3^+、CD4^+、CD8^+)比例、CD4^+/CD8^+。结果:食管癌肿瘤直径、同步化疗和放疗总量均与放射性肺损伤的发生相关(P<0.05);RP组的双肺受照平均剂量(MLD)和肺V25、V20、V5均明显大于非RP组;RP组与非RP组放疗后的LC、CRP以及CD3^+、CD4^+T细胞亚群比例和CD4^+/CD8^+,差异均有统计学意义(P<0.05),RP组放疗前后LC以及CD3^+、CD4^+、CD8^+T细胞亚群比例和CD4^+/CDD8^+差异均有统计学意义(P<0.05)。结论:食管癌放疗引起的放射性肺损伤是一个多因素参与的炎性反应病理过程,与放射物理参数和患者的免疫功能有关。

Objective：To explore the correlations of clinical physical parameters and immunological indexes in patients with middle and lower esophageal cancer who underwent three-dimensional conformal radiotherapy （3DCRT） with radiation pneumonitis（RP）.Methods：The clinical data of 46 patients with middle and lower esophageal cancer who underwent 3DCRT for the first time were collected.The correlations of age,gender,tumor diameter,TNM stage,bilateral lung volume,concurrent chemotherapy,radiotherapy dose and radiation fields with the incidence of RP were analyzed.By utilizing target isodose curves and dose volume histograms （DVH）,the target and lung dose parameters of 3DCRT in RP patients （RP group） were analyzed.Lymphocytes （LC）,C-reactive protein （CRP）,T cell subsets （CD3＋,CD4＋,CD8＋） and ratio （CD4＋ /CD8＋） in venous blood were compared between RP group and non RP patients （non-RP group） after radiotherapy.Results：Esophageal tumor diameter,concurrent chemotherapy and radiotherapy dose were correlated to RP （P＜0.05）.Lung MLD,and V25,V20,V5 of RP group were significantly greater than those of non-RP group.Meanwhile,there were significant differences in LC,CRP,T cell subsets of CD3＋ and CD4＋,as well as CD4＋ /CD8＋ between RP group and non-RP group after radiotherapy （P＜ 0.05）.LC,T cell subsets of CD3＋,CD4 ＋ and CD8＋,as well as CD4/CD8 in RP group were significantly different before and after the radiotherapy.Conclusions：RP caused by esophageal cancer radiotherapy was an inflammation pathological process with multiple factors involved,which was correlated to radiation physical parameters and the immunological functions of the patients.