螺旋断层放疗模式下非小细胞肺癌急性重度放射性食管炎的相关因素

Impact of dose volume parameters and clinical factors on severe acute radiation-induced esophagitis for NSCLC patients treated with tomotherapy

目的分析螺旋断层放疗模式下非小细胞肺癌患者中急性重度放射性食管炎的发生率和相关因素。方法前瞻性收集根治目的下螺旋断层放疗配合同期化疗或序贯化疗的局部晚期或寡转移非小细胞肺癌病例共62例,对相关放射剂量体积资料和治疗毒性的临床资料进行统计分析。结果急性重度放射性食管炎的发生率为24.2%,均为3级,无4~5级毒性。化疗方式、食管中位剂量、食管V25、V55是3度急性放射性食管炎的影响因素。结合ROC曲线及临床实际,序贯化疗、食管中位剂量<49 Gy、食管V25<64%、V55<33%、V60<15%,与3度放射性食管炎低发生率相关。其中,食管V55预测价值较好(AUC=0.863),以33%作为最佳截断值,其敏感性、特异性分别为86.7%、83.0%。结论螺旋断层放疗模式下,局部晚期或寡转移非小细胞肺癌急性重度放射性食管炎的发生率与其他放疗技术相似,应综合分析各参数优化放疗计划。

Objective To identify clinical and dosimetric parameters from dose-volume histogram （DVH） relating with incidence of severe acute radiation-induced esophagitis （RE） in patients with non-small cell lung can- cer （NSCLC） underwent tomotherapy with concurrent or sequential chemotherapy. Methods Recm＇ds about clini- cal information and treatment plan parameters from DVH of 62 NSCLC patients treated with tomotherapy were pro- spectively collected to assess the correlation to severe acute RE from January 2012 to December 2016. Results There were 24.2% patients developed grade 3 RE, grade 4 or 5 in 0% patients. Multivariate analysis indicated that concurrent chemotherapy, esophagus median dose and esophagus V25 and V55 were the influencing factors of RE. The incidence of low frequencies RE was correlated with sequential chemotherapy, esophagus median dose 〈 49 Gy, esophagus V25 〈 64% , V55 〈 33% and V60 〈 15%. Conclusions For NSCLC patients treated with tomo- therapy and chemotherapy, the occurrence of acute RE was similar to that of other techniques. It is recommended to balance such parameters for optimizing treatment planning.