食管癌调强放射治疗的初期疗效及急性放射性肺损伤的影响因素分析

Analysis of the Initial Efficacy of Intensity Modulated Radiotherapy for Esophageal Cancer and the Influencing Factors of Acute Radiation-induced Lung Injury

目的:探讨食管癌调强放射治疗的初期疗效及急性放射性肺损伤的影响因素。方法:选取2015年1月-2019年1月在我院进行调强放射治疗的食管癌患者322例,评价食管癌调强放射治疗后一个月的疗效;按照是否发生急性放射性肺损伤(RILI)分为急性RILI组和无急性RILI组,采用多因素Logistic回归分析分析急性RILI的影响因素。结果:调强放射治疗的完全缓解和部分缓解的患者占98.45%;322例患者中90例(27.95%)出现急性RILI,其中36例(11.18%)出现2级及以上的急性RILI;急性RILI组和无急性RILI组间卡氏(KPS)评分、淋巴结转移、基础肺疾病、V5、V10、V20、V30和全肺平均剂量(MLD)差异有统计学意义(P<0.05);多因素Logistic回归分析显示,KPS评分<80分、有淋巴结转移、有基础肺疾病,V5≥60%、V10≥40%、V20≥28%、V30≥20%和MLD≥10Gy是食管癌调强放射治疗后急性放射性肺损伤的危险因素(P<0.05)。结论:使用调强放射治疗技术治疗食管癌的初期疗效较好,治疗过程中,应充分考虑病患的临床特征,优化放疗方案和靶区,减少急性RILI的发生,提高食管癌患者放疗后的生存质量。

Objective:To investigate the initial efficacy of intensity modulated radiotherapy for esophageal cancer and the influencing factors of acute radiation-induced lung injury.Methods:A total of 322 patients with esophageal cancer who underwent intensity-modulated radiotherapy in our hospital from March 2015 to March 2019 were selected,to evaluate the effect of intensity-modulated radiotherapy on esophageal cancer one month later.The patients were divided into two groups:acute RILI group and non acute RILI group according to the occurrence of acute radiation lung injury(RILI),the influencing factors of acute RILI was analysised by multivariate logistic regression.Results:Patients with complete and partial response to intensity-modulated radiotherapy accounted for 98.45%;90 of the 322 patients(27.95%)developed acute RILI,of which 36(11.18%)experienced grade 2 or higher acute RILI;There was statistically significant differences in KPS scores,lymph node metastasis,basal lung disease,V5,V10,V20,V30,and mean lung dose between the group and the non-acute RILI group(P<0.05);multivariate logistic regression analysis showed that KPS<80 scores,with lymph node metastasis,with underlying lung disease,V5≥60%,V10≥40%,V20≥28%,V30≥20%,and mean lung dose≥10 Gy are acute radiation lungs after intensity modulated radiotherapy for esophageal cancer independent risk factors for injury(P<0.05).Conclusion:The initial efficacy of intensity-modulated radiotherapy for esophageal cancer is well.During intensity-modulated radiotherapy treatment,In the treatment process using intensity modulated radiotherapy,the clinical characteristics of patients should be fully considered,the radiotherapy plan and target area should be optimized,the incidence of acute RILI would be reduced,and the quality of life of patients with esophageal cancer after radiotherapy would be improved.