老年人局部晚期食管癌放疗所致放射性肺损伤的相关因素分析

Analysis of related factors of radiation induced lung injury after radiotherapy in the elderly patients withadvance esophageal cancer

目的观察老年局部晚期食管癌患者三维适形放疗（3D-CRT）后放射性肺损伤（RILI）发生的相关因素，以指导临床放疗计划有效、安全执行。方法回顾性分析行3D-CRT的72例老年局部晚期食管癌患者的临床资料及放疗物理参数，包括患者性别、年龄、卡氏评分、吸烟史、病变部位、T分期、基础肺疾病、放疗剂量、全肺接受5 Gy的照射体积（V5）、V10、V15、V20、V25、V30、V35、V40及平均肺剂量（MLD）。结果在72例老年食管癌患者中，有15例发生RILI。单因素分析显示，RILI与高龄、基础肺疾病、V5、V10、V15、V20、V25及MLD有相关性（χ2＝5.098，P＝0.026；χ2＝3.598，P＝0.030；t＝3.854，P＝0.034；t＝4.901，P＝0.022；t＝4.638，P＝0.029；t＝5.122，P＝0.015；t＝3.652，P＝0.041；t＝5.760，P＝0.010）。结论老年食管癌患者放射治疗过程中，应充分考虑高龄、基础肺疾病、V5、V10、V15、V20、V25及MLD等因素，减少发生放射性肺损伤的风险。

ObjectiveTo study the related factors of radiation induced lung injury（RILI） after three-dimensional conformal radiotherapy（3D-CRT） in the elderly patients with advance esophageal cancer, thus to provide reference for radiotherapy planning.MethodsThe clinical data and physical parameters of 72 elderly patients with advance esophageal cancer were analyzed, including gender, age, performance status scoring, smoking history, tumor location, T staging, underlying disease of the lung, radiation dose, the whole lung accepted 5 Gy exposure volume（V5）, V10, V15, V20, V25, V30, V40 and mean lung dose（MLD）.ResultsAmong 72 patients, 15 cases developed RILI.It was revealed by univariate analysis that there were statistically significant differences in advanced age, underlying disease of the lung, V5, V10, V15, V20, V25, MLD with RILI（χ2=5.098, P=0.026; χ2=3.598, P=0.030; t=3.854, P=0.034; t=4.901, P=0.022, t=4.638, P=0.029, t=5.122, P=0.015, t=3.652, P=0.041, t=5.760, P=0.010）.ConclusionIt should be payed more attention to factors such as advanced age, underlying disease of the lung, V5, V10, V15, V20, V25 and MLD when elderly patients with advance esophageal cancer patients were treated with 3D-CRT in order to prevent and decrease the risks of RILI.