食管癌调强放疗下发生急性放射肺损伤的危险因素分析

Risk factors of acute radiation lung injury caused by intensity-modulated radiotherapy for esophageal cancer

目的分析食管癌调强放疗下发生急性放射肺损伤(ARLI)的危险因素。方法抽取2018年6月至2019年12月大同煤矿集团有限责任公司肿瘤医院收治的食管癌患者87例,均于食管癌术后接受调强放疗,记录放疗3个月内ARLI发生情况,并行Logistic相关危险因素分析。结果 87例食管癌患者调强放疗后发生ARLI 24例,ARLI发生率为27.59%。不同放射剂量学因素、肿瘤靶区体积及处方剂量与ARLI有相关性(P<0.05),年龄、性别、吸烟史、病理类型、肿瘤T分期、肺部合并症及两肺体积与ARLI未见相关性(P>0.05)。Logistic回归分析显示,V5≥63%、V30≥5%是ARLI的独立危险因素(P<0.05)。结论食管癌调强放疗下ARLI的发生与V5≥63%、V30≥5%密切相关,放疗中应避免采用这两种放射剂量。

Objective To investigate the risk factors of acute radiation lung injury(ARLIA)caused by intensity-modulated radiotherapy for esophageal cancer.Methods Eighty-seven patients with esophageal cancer admitted to the Cancer Hospital of Datong Coal Mine Group from June 2018 to December 2019 were selected,all patients received intensity-modulated radiotherapy after esophageal cancer surgery.The occurrence of ARLI within 3 months of radiotherapy was recorded,and Logistic related risk factors were analyzed.Results There were 24 cases of ARLI in 87 patients with esophageal cancer after intensity-modulated radiotherapy,and the incidence of ARLI was 27.59%.The occurrence of ARLI was related to different dosimetric factors,tumor target volume and prescription dose(P<0.05),while it was not correlated with age,gender,smoking history,pathological type,tumor T stage,pulmonary complications and lung volume(P<0.05).Logistic regression analysis showed that V5≥63%and V30≥5%were independent risk factors for ARLI(P<0.05).Conclusions The occurrence of ARLI caused by intensity-modulated radiotherapy for esophageal cancer is closely related to V5≥63%and V30≥5%.These two radiation doses should be avoided in radiotherapy.