老年食管癌患者调强放疗效果及发生放射性肺炎因素分析

The effects of intensity modulated radiation and the risk factors of radiation pneumonia in elderly patients with esophageal cancer

目的:探讨老年食管癌患者调强放疗效果及分析发生放射性肺炎的危险因素。方法:对2018年2月至2020年2月昆山市中医医院进行调强放疗的80例老年食管癌患者的临床资料进行分析,统计其治疗效果和不良反应发生情况,分析发生放射性肺炎的危险因素。结果:80例患者治疗期间发生放射性肺炎13例。单因素分析结果表明,性别、吸烟史、病理分期、年龄与放射性肺炎发生无相关性(P>0.05),而肿瘤位置、糖尿病、同步化疗、再程放疗、慢性阻塞性肺疾病与放射性肺炎发生相关(P<0.05)。放射性肺炎和非放射性肺炎患者V30、V35、V40比较差异无统计学意义(P>0.05);两组V5、V10、V15、V20和全肺照射的平均剂量(MLD)比较差异有统计学意义(P<0.05)。调强放疗效果为病情无缓解9例(11.25%)、部分缓解59例(73.75%),完全缓解12例(15.00%),临床有效率为88.75%(71/80)。调强放疗导致的不良反应中,放射性食管炎、白细胞减少、急性放射性肺炎发生率分别为93.75%(75/80)、12.50%(10/80)、22.50%(18/80),不良反应程度均为1、2级。结论:老年食管癌患者在调强放疗后发生放射性肺炎的危险因素包括肿瘤位置、糖尿病、V5、V10、V15、V20、MLD、同步化疗、再程放疗、慢性阻塞性肺疾病。

Objective To investigate the effects of intensity modulated radiation therapy(imRT)and risk factors of radiation pneumonia caused by imRT in elderly patients with esophageal cancer.Methods The clinical data of 80 elderly patients diagnosed with esophageal cancer and performed imRT in Traditional Chinese Medicine Hospital of Kunshan from February 2018 to February 2020 were analyzed,and the therapeutic effect and the incidence of adverse reactions were counted.Results In the 80 patients,13 patients occurred radiation pneumonia.The results of univariate analysis showed that the gender,smoking history,pathological stage and age had no correlation with radiation pneumonia(P>0.05),while tumor location,diabetes,concurrent chemotherapy,reradiotherapy and chronic obstructive pulmonary disease had correlation with the occurrence of radioactive pneumonia(P<0.05).The levels of V30,V35,V40 between radioactive pneumonia patients and non-radioactive pneumonia patients had no significant differences(P>0.05),but the levels of V5,V10,V15,V20 and mean lung dose(MLD)between radioactive pneumonia patients and non-radioactive pneumonia patients had significant differences(P<0.05).The effect of imRT was no remission in 9 cases(11.25%),partial remission in 59 cases(73.75%)and complete remission in 12 cases(15.00%),and the clinical effective rate was 88.75%(71/80).By comparing the adverse reactions caused by imRT,it was found that the incidence of radiation esophagitis,leukopenia,and acute radiation pneumonia were 93.75%(75/80),12.50%(10/80)and 22.50%(18/80),respectively,with grade 1 and grade 2 adverse reactions.Conclusions Risk factors for radiation pneumonia in elderly patients with esophageal cancer after imRT include tumor location,diabetes,V5,V10,V15,V20,MLD,concurrent chemotherapy,reradiotherapy and chronic obstructive pulmonary disease.