局部晚期非小细胞肺癌患者同步放化疗急性食管炎预测因素研究

Predictive factors for acute esophagitis in patients with locally advanced non-small cell lung cancer treated with intensity modulated radiation concurrent chemotherapy

目的:研究局部晚期非小细胞肺癌(NSCLC)患者强调放射治疗(IMRT)合并化疗时急性食管炎的发生率及相关预测因素。方法:收集IMRT同步化疗未手术Ⅲ期NSCLC患者156例。放疗靶区包括原发肺肿瘤及受累淋巴引流区,中位剂量为60Gy,分30次(50~70Gy)。放疗期间及放疗结束后3个月内出现≥2级急性食管炎作为终点事件,采用CTCAE3.0评估急性食管炎级别,并采用Logistic回归模型对预测因素进行分析。结果:156例中,出现治疗相关≥2级急性食管炎122例(78.2%),其中2级99例(63.5%)、3级23例(14.7%);≥2级急性食管炎发生时的中位剂量为26Gy(8~64Gy);食管V5-V60、食管平均剂量及年龄是≥2级急性食管炎的预测因素(P=0.019、0.0.0.02),其中高龄和高体重指数是保护性因素。结论:局部晚期NSCLC患者IMRT同步化疗时,食管V50对预测≥2级急性食管炎有较高价值。

Objective:To study the incidence and related predictive factors for acute esophagitis in patients with locally advanced non-small cell lung cancer(NSCLC)treated with intensity modulated radiation(IM R T)concurrent chemotherapy.M ethods:Data were collected retrospectively from156patients with inoperable or unresectable stage H[NSCLC treated in our hospital between January2010and December2016.The radiotherapy target volume included primary lung cancer and lymphatic drainage area involved,with a median dose of60Gy in30fractions(50-70Gy).Grade^2acute esophagitis(A E)which occurred during radiotherapy and within3months after completion of radiotherapy served as the outcome event.National Cancer Institute Common Terminology Criteria for A dverse Events version3.0CNCI-CTCA3.0)was used to evaluated the grade of AE.The logistic regression model was used to analyze the predictive factors.Results:A total of122patients(78.2%)had treatment-related grade^2A E;99patients(63.5%)had grade2AE and23patients(14.7%)had grade3AE.The median dose when grade^2AE occurred was26G y(8-64G y).For grade^2A E,multivariate analysis showed that esophageal V5-V60,m ean dose,and age were independent predictive factors(P=0.021,0,0.010).Old age and higher BMI were the predictive factors.Conclusions For patients with locally advanced NSCLC treated with IM RT concurrent chemotherapy,esophageal V50are high predictive value for grade^2A E.