胰腺癌TOMO高剂量少分次放射治疗后胃镜下黏膜损伤相关因素研究

Predictive factors for gastrointestinal toxicity based on endoscopy after tomotherapy(TOMO) hypofractioned radiotherapy for pancreatic adenocarcinoma

目的:探讨采用螺旋断层放射治疗高剂量、少分次模式治疗胰腺癌的胃镜下胃肠黏膜损伤表现,及其与剂量学和临床因素的相关性。方法:选取23例胰腺癌患者,并接受TOMO设备治疗,按照高剂量少分次剂量模式,放射治疗前(1周内)及放射治疗结束后(1周内)均行胃镜检查。采用CTCAE v4.0分级标准和胃镜下黏膜反应标准分级,分析胃镜下分级与CTCAE分级、临床因素、胃及十二指肠剂量体积参数间的关系。Logistic多因素回归分析筛选胃镜下分级的影响因素。结果:Spearman相关分析显示,十二指肠D_(max)与胃镜下≥2级放射性胃肠损伤的发生具有相关性(r=0.523,P<0.05);十二指肠D_(max)、D_1(1 cm^3所接受的最大剂量)、D_3(3 cm^3所接受的最大剂量)、V_(45)与≥胃镜下3级放射性胃肠损伤的发生具有相关性(r=0.599,r=0.464,r=0.428,r=0.465;P<0.05)。十二指肠D_(max)、D_1、D_3、V_(40)、V_(45)与≥胃镜下4级放射性胃肠损伤的发生具有统计学意义(r=0.497,r=0.457,r=0.464,r=0.441,r=0.479;P<0.05)。多因素Logistic回归结果显示,胃镜下放射性胃肠黏膜损伤分级与CTCAE分级、临床因素及剂量参数间无差异。结论:胰腺癌螺旋断层放射治疗高剂量、少分次模式治疗后,胃镜下胃肠黏膜损伤的发生与主观症状、临床因素及剂量学因素无相关性,有待进一步研究。

Objective：To observe the endoscopic findings of gastrointestinal toxicity in pancreatic adenocarcinoma patients following tomotherapy（TOMO） hypofractioned radiotherapy, and to explore the relationship between occurrence of gastrointestinal（GI） toxicity and clinical factors.Methods： Analysis of the endoscopy before and after radiation of 23 pancreatic adenocarcinoma patients received TOMO hypofractioned radiotherapy. GI toxicity was scored by the National Cancer Institute Common Terminology Criteria for Adverse Events （CTCAE） version 4.0 and criteria of GI toxicity in endoscopy. Logistic regression models were performed to identify risk factors associated with GI toxicity.Results： On UVA, onlyDmax of the duodenum was significantly related with ≥grade II GI toxicity based on endoscopy（r=0.523,P〈0.05）. TheDmax,D1,D3,V45 of the duodenum were significantly related with ≥grade III toxicity based on endoscopy（r=0.599,r=0.464,r=0.428,r=0.465,P〈0.05）, and theDmax,D1,D3,V40,V45 of the duodenum were significantly related with ≥grade IV GI toxicity based on endoscopy（r=0.497,r=0.457,r=0.464,r=0.441,r=0.479, P〈0.05）. On MVA, There was no correlation between GI toxicity based on endoscopy and GI toxicity based on CTCAE （P〉0.05）. No clinical and dose-volume parameters was significantly associated with the GI toxicity based on endoscopy （P〉0.05）.Conclusions： There was no correlation between subjective symptoms, clinical and dose-volume parameters and GI toxicity based on endoscopy after TOMO hypofractioned radiotherapy for pancreatic adenocarcinoma and it is worth of a step further research.