80岁以上老年食管鳞癌调强放疗致放射性肺损伤的影响因素

Influence factors of radiation-induced lung injury after intensity-modulated radiotherapy in elderly(above 80 years) patients with esophageal squamous carcinoma

目的探讨80岁以上老年食管鳞癌调强放疗致放射性肺损伤(radiation-induced lung injury,RILI)的影响因素。方法回顾性分析2014年5月至2016年10月在我院接受调强放疗的94例80岁以上老年食管鳞癌患者的临床资料,采用多因素Logistic回归分析RILI发生的影响因素。结果 94例患者RILI发生率为24.5%(23/94),单因素分析显示吸烟史、肺部有基础疾病、双肺V_5和双肺V_(20)与RILI发生有关(P<0.05)。多因素分析显示V_5≤55%是RILI的保护因素(OR=0.072,95%CI:0.017～0.308,P<0.001),肺部有基础疾病是发生RILI的危险因素(OR=11.289,95%CI:2.186～58.312,P=0.004)。结论 80岁以上食管鳞癌患者调强放疗致放射性肺损伤的发生率较高,肺部有基础疾病可增加放射性肺损伤的发生风险,控制双肺V_5≤55%可有效减少RILI的发生。

Objective To analyze the influence factors of radiation-induced lung injury（RILI）after intensity-modulated radiotherapy in elderly（above 80 years）patients with esophageal squamous carcinoma. Methods Clinical data of 94 elderly（above 80 years）patients with esophageal squamous cell carcinoma who underwent intensity-modulated radiotherapy from May 2014 to October 2016 were analyzed. Influencing factors of RILI were identified using multivariate logistic regression analysis. Results Among the 94 patients,the incidence of RILI was 24.5%（23/94）. Univariate analysis identified the following risk factors：smoking, underlying lung diseases, and lung V_5（P0.05）. Multivariate analysis identified lung V_5≤55% as a protective factor for RILI（OR=0.072,95%CI：0.017-0.308,P0.001）,and underlying lung disease was a risk factor（OR=11.289,95%CI：2.186-58.312,P=0.004）. Conclusions The incidence of radiation-induced lung injury is high after intensity-modulated radiotherapy in elderly（above 80 years）patients with esophageal squamous carcinoma.Underlying lung diseases increases incidence risk of RILI,and lung V_5≤55% can effectively reduce the occurrence of RILI.