高原地区低剂量食管癌根治性放疗后放射性肺炎影响因素分析

Influencing Factors of Radiation Pneumonia after Low Dose Radical Radiotherapy for Esophageal Cancer in Plateau Area

目的基于纵向队列分析高原地区低剂量食管癌根治性放疗后放射性肺炎(radiation pneumonia,RP)发生的影响因素。方法回顾性分析2020年7月至2023年6月在云南省肿瘤医院放疗科进行根治性放疗的172例食管癌患者资料,按照美国国立癌症研究所常见不良反应术语评定标准5.0版(CTCAE 5.0)进行放射性肺炎的评级,分别收集临床因素、传统独立剂量学特征和剂量区间变化特征。对用于预测是否发生症状性放射性肺炎的特征进行相关性分析,使用结构聚类法进行特征筛选,使用逻辑回归(logisitc regression,LR)进行多因素分析,并用Python进行可视化展示。结果全组172例患者发生RP 81例(47.09%),其中1级53例(30.8%),2级13例(7.5%),3级12例(6.9%),4级3例(1.7%);123例(71.51%)患者接受≤50.4 Gy的低剂量照射;多因素分析显示体力评分(performance Status,PS),间质性肺炎(interstitial pneumonia,IP),处方剂量(plan_dose)是放射性肺炎发生的独立预后因素。结论低剂量背景下高原地区食管癌根治性放疗是安全的,对体力评分较差及既往合并间质性肺炎的患者应谨慎决定放疗剂量。

Objective To analyze the factors influencing the occurrence of radiation pneumonia(RP)after radical radiotherapy for esophageal cancer in plateau area under the background of low dose based on longitudinal cohort.Methods A retrospective analysis was conducted on the data of 172 esophageal cancer patients who underwent radical radiotherapy at our hospital from July 2020 to June 2023.RP was rated according to the National Cancer Institute Common Adverse Reaction Terminology Evaluation Standard 5.0(CTCAE 5.0).Clinical factors,traditional independent dosimetry characteristics and dose-interval variation characteristics were collected.Correlation analysis was performed for the features used to predict the occurrence of symptomatic RP,feature screening was performed with structural clustering,multi-factor analysis was performed with logisitc regression(LR),and visualization was performed with Python.Results The incidence of RP was 81 cases(47.09%)in 172 patients,including 53 cases(30.8%)in grade 1,13 cases(7.5%)in grade 2,12 cases(6.9%)in grade 3,and 3 cases(1.7%)in grade 4.123 patients(71.51%)received a low dose of≤50.4 Gy;Multivariate analysis showed that physical strength score(PS),interstitial pneumonia(IP),and prescribed dose(plan_dose)were independent prognostic factors for RP.Conclusion Radical radiotherapy for esophageal cancer in plateau area is safe under low dose background,and the radiotherapy dose should be carefully determined for patients with poor physical scores and prior interstitial pneumonia.