局部晚期非小细胞肺癌调强放疗后毒性研究

Study on toxicity of intensity-modulated radiotherapy for locally advanced non small cell lung cancer

目的探究局部晚期非小细胞肺癌调强放疗后毒性反应情况。方法选择2014年8月—2016年9月期间在本院行调强放疗的70例局部晚期非小细胞肺癌患者作为研究对象。本组患者均采用固定野调强放疗技术,单次分割剂量均为2 Gy,5次/周,所有患者均行6~8个周期的治疗,观察患者放疗期间及放疗结束后3个月内不良反应发生情况,依据美国癌症研究所的CTCAE3.0常见毒性分级标准评估患者不良反应情况,采用RTOG分级标准评估患者放射性食管炎或放射性肺损伤,并统计分析发生时间及发生率。计量资料采用t检验,计数资料采用χ~2检验,P<0.05为差异有统计学意义。结果本组患者放疗后放射性食管炎发生率为68.57%,发生时间为放疗5~49 d,中位时间为27 d。2级放射性食管炎占比最高(58.57%),显著高于1级(2.86%)和3级(7.14%)占比,对比差异有统计学意义(P<0.05)。1级放射性食管炎占比(2.86%)显著少于3级(7.14%),对比差异有统计学意义(P<0.05)。放疗后放射性肺损伤发生率为36.62%,发生时间为放疗后10~77 d,中位时间为44 d。2级放射性肺损伤占比最高(21.43%)显著高于1级(14.29%)和3级(8.57%)占比,对比差异有统计学意义(P<0.05)。本组患者中出现白细胞降低(14.29%),血小板降低(16.90%),放射性皮炎(15.71%),三者均低于放射性肺损伤(36.62%)和放射性食管炎(68.57%)发生率,对比差异有统计学意义(P<0.05)。结论局部晚期非小细胞肺癌调强放疗后毒性反应以放射性食管炎和放射性肺损伤为主,应合理调整放疗剂量,及时做好两者监测及防控干预,进而保证调强放疗治疗效果。

Objective Study on the toxicity of locally advanced non-small cell lung cancer after intensity-modulated radiotherapy.Methods 70 patients with locally advanced non-small cell lung cancer treated with intensity-modulated radiation therapy in our hospital during August 2014 to September 2016 were selected as the study subjects.The patients were treated with intensity-modulated radiotherapy,single fraction dose was 2 Gy,5 times/week,all patients underwent 6-8 treatment period of 3 months,incidence of adverse reactions were observed during radiotherapy and after radiotherapy,according to the American institute for cancer research（NCI） to evaluate the adverse reactions of patients of CTCAE3.0 common toxicity grading criteria,using RTOG classification standard assessment of patients with esophagitis/lung injury,and statistical analysis of the occurrence time and the incidence.Count data was processed by chi sqare test,the result of P〈0.05 was considered statistically significant.Result In this group,the incidence of radiation esophagitis after radiotherapy was 68.57%,and the time was 5-49 d,the median time was 27 d.The grade 2 highest proportion of radiation esophagitis（58.57%） was significantly higher than that of grade 1（2.86%） and grade 3（7.14%）,the difference was significant（P〈0.05）.The proportion of grade 1 radiation esophagitis（2.86%） was significantly less than grade 3（7.14%）,the difference was significant（P〈0.05）.The incidence of radiation-induced lung injury was 36.62%,and the time was 10-77 d after radiotherapy.The median time was 44 d.The highest proportion of 2 grade radiation lung injury（21.43%） was significantly higher than that of grade 1（14.29%） and grade 3（8.57%）,the difference was significant（P〈0.05）.This group of white blood cells decreased（14.29%）,platelets decreased（16.90%）,radioaetive 15.71%,and all the three are lower than that of radioactive dermatitis,radiation-induced lung injury（36.62%） and esophagitis（68.57%）,the difference was significant（P〈0.05）.Conclusion Local advanced non small cell lung cancer toxicity after intensity-modulated radiotherapy with radiation esophagitis and radiation-induced lung injury,should adjust the radiation dose in a timely manner,both monitoring and prevention and control,and to ensure that the IMRT treatment effect.