调强放疗剂量对食管癌患者胃部放射性损伤的影响

Effect of intensity modulated radiotherapy dose on gastric radiation injury in patients with esophageal cancer

目的探讨调强放疗剂量对食管癌患者胃部放射性损伤的影响。方法选取2016年1月至2019年12月间江苏省徐州市矿务集团总医院收治的行食管癌放疗的72例食管癌患者为研究对象,其中出现2级及以上急性放射性胸腔胃炎的患者24例。使用受试者工作曲线(ROC)分析胃D_(max),胃D_(mean),5~50Gy照射长度L5、L10、L15、L20、L25、L30、L35、L40,5~50Gy照射的胃体积百分数V5、V10、V15、V20、V25、V30、V35、V40、V45、V50临界值。比较不同胃D_(max)、胃D_(mean)水平以及不同5~50Gy照射长度、5~50Gy照射的胃体积百分数下患者胃部放射性损伤的发生情况。对单因素比较有统计学意义的指标进行Logistics多因素回归分析,研究调强放疗剂量对食管癌患者尾部放射性损伤的影响。结果ROC曲线分析显示,胃D_(max)界值为6210 Gy,胃D_(mean)界值为3566 Gy,L5-L40界值分别为16.7cm、12.7cm、10.5cm、10.3cm、8.3cm、8.1cm、4.4cm和3.5cm,V5-V50界值分别为98.8%、79.3%、74.2%、72.5%、60.0%、46.1%、43.7%、35.5%、22.2%和12.7%。单因素比较结果显示,不同胃D_(max)、胃D_(mean)、L5-L40和V10-V50水平患者发生急性放射性胸腔胃炎的比较,差异有统计学意义(P<0.05)。Logistics多因素回归分析显示,L5和V40是食管癌患者发生胃部放射性损伤的相关因素,差异有统计学意义(P<0.05)。结论调强放疗剂量对食管癌患者发生胃部放射性损伤有明显影响,其中5Gy放射量照射长度和40Gy放射量照射胃体积百分数可以作为预测胃部放射性损伤的指标。

Objective To explore the effect of intensity modulated radiotherapy(IMRT)dose on gastric radiation injury in patients with esophageal cancer.Methods A total of 72 patients who received radical treatment for esophageal cancer at General Hospital of Xuzhou Mining Bureau from January 2016 to December 2019 were selected as the research subjects,among which 24 patients presented with grade 2 or above acute radiative pleural gastritis.Receiver operating characteristic curve(ROC)was used to analyze critical value of gastric D_(max),gastric D_(mean),exposure length of L5,L10,L15,L20,L25,L30,L35 and L40 for 5 to 50 Gy and gastric volume percentage V5,V10,V15,V20,V25,V30,V35,V40,V45,and V50 for 5 to 50 Gy exposure.The incidence of gastric radiation injury in patients of different gastric D_(max)and gastric D_(mean)levels,and different 5 to 50 Gy irradiation length and 5 to 50 Gy irradiation percentage of gastric volume were compared.Logistics multi-factor regression analysis was conducted for the indexes with statistically significant univariate comparison to study the effect of IMRT dose on radiation injury of tail in esophageal cancer patients.Results The ROC curve analysis showed that critical value was 6210 Gy for gastric D_(max)and 3566 Gy for the gastric D_(mean).The critical value of L5 to L40 was 16.7 cm,12.7 cm,10.5 cm,10.3 cm,8.3 cm,8.1 cm,4.4 cm and 3.5 cm,respectively and the critical value of V5 to V50 was98.8%,79.3%,74.2%,72.5%,60.0%,46.1%,43.7%,35.5%,22.2%and 12.7%,respectively.The results of univariate comparison showed significant defenses in the incidence of acute radioactive pleural gastritis in patients with different gastric D_(max),gastric D_(mean),L5 to L40 and V10 to V50 levels(P<0.05).Logistic multivariate regression analysis showed that L5 and V40 were the factors influencing gastric radiation injury in esophageal cancer patients(P<0.05).Conclusion IMRT dose has significant influence on gastric radiation injury in patients with esophageal cancer,among which the length of 5 Gy radiation dose and the percentage of stomach volume exposed to 40 Gy radiation dose can be used as indicators to predict gastric radiation injury.