Multiple regression analysis of risk factors related to radiation pneumonitis

BACKGROUND Radiation pneumonitis(RP)is a severe complication of thoracic radiotherapy that may lead to dyspnea and lung fibrosis,and negatively affects patients’quality of life.AIM To carry out multiple regression analysis on the influencing factors of radiation pneumonitis.METHODS Records of 234 patients receiving chest radiotherapy in Huzhou Central Hospital(Huzhou,Zhejiang Province,China)from January 2018 to February 2021,and the patients were divided into either a study group or a control group based on the presence of radiation pneumonitis or not.Among them,93 patients with radiation pneumonitis were included in the study group and 141 without radiation pneumonitis were included in the control group.General characteristics,and radiation and imaging examination data of the two groups were collected and compared.Due to the statistical significance observed,multiple regression analysis was performed on age,tumor type,chemotherapy history,forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),carbon monoxide diffusion volume(DLCO),FEV1/FVC ratio,planned target area(PTV),mean lung dose(MLD),total number of radiation fields,percentage of lung tissue in total lung volume(vdose),probability of normal tissue complications(NTCP),and other factors.RESULTS The proportions of patients aged≥60 years and those with the diagnosis of lung cancer and a history of chemotherapy in the study group were higher than those in the control group(P<0.05);FEV1,DLCO,and FEV1/FVC ratio in the study group were lower than those in the control group(P<0.05),while PTV,MLD,total field number,vdose,and NTCP were higher than in the control group(P<0.05).Logistic regression analysis showed that age,lung cancer diagnosis,chemotherapy history,FEV1,FEV1/FVC ratio,PTV,MLD,total number of radiation fields,vdose,and NTCP were risk factors for radiation pneumonitis.CONCLUSION We have identified patient age,type of lung cancer,history of chemotherapy,lung function,and radiotherapy parameters as risk factors for radiation pneumonitis.Comprehensive evaluation and examination should be carried out before radiotherapy to effectively prevent radiation pneumonitis.

Experimental treatment of radiation pneumonitis with human umbilical cord mesenchymal stem cells

Objective:To evaluate of the curative effect of human umbilical cord mesenchymal stem cells(hUC-MSCs)on rat acute radiation pneumonitis.Methods:Fourty rats were randomly divided into control group,radiation group,stem cell prevention group,stem cell treatment group and prednisone treatment group.All rats except those in the control group were radiated with X ray to establish the acute radiation pneumonitis damage model.The hUC-MSCs cultured in vitro was administrated to the rats of the prevention group via tail vein(1×10~6 cells/kg BW)24 h before the radiation,while the same administration was performed in the rats of the treatment group 24 h after the radiation.After 24 h post the radiation,the rats in tbe radiation group were given 0.4 mL physiological saline,and those in the prednisone group were given 1 mg/kg prednisone.All rats were,observed and executed 72 h after the radiation to defect lung histological changes.Results:After the administration of hUC-MSCs,the survival status of the rats in the prevention group and treatment group was obviously better than that in the control group.As shown by the histological staining,the morphology,proliferation activity aad bronchial state of lung tissues were better in the prevention group and treatment group than in the control group.Conclusion:The hUC-MSCs have definite therapeutic effects on acute radiation pneumonitis in rats.

Radiation pneumonitis after stereotactic radiation therapy for lung cancer

Stereotactic body radiation therapy(SBRT)has a locacontrol rate of 95%at 2 years for non-small cell lungcancer(NSCLC)and should improve the prognosis oinoperable patients,elderly patients,and patients withsignificant comorbidities who have early-stage NSCLCThe safety of SBRT is being confirmed in internationalmulti-institutional PhaseⅡtrials for peripheral lungcancer in both inoperable and operable patients,bureports so far have found that SBRT is a safe and effective treatment for early-stage NSCLC and early metastatic lung cancer.Radiation pneumonitis(RP)is oneof the most common toxicities of SBRT.Although mospost-treatment RP is Grade 1 or 2 and either asymptomatic or manageable,a few cases are severe,symptomatic,and there is a risk for mortality.The reportedrates of symptomatic RP after SBRT range from 9%to28%.Being able to predict the risk of RP after SBRT isextremely useful in treatment planning.A dose-effecrelationship has been demonstrated,but suggesteddose-volume factors like mean lung dose,lung V20and/or lung V2.5 differed among the reports.We foundthat patients who present with an interstitial pneumo-nitis shadow on computed tomography scan and high levels of serum Krebs von den Lungen-6 and surfactant protein D have a high rate of severe radiation pneumo-nitis after SBRT.At our institution,lung cancer patients with these risk factors have not received SBRT since 2006,and our rate of severe RP after SBRT has de-creased significantly since then.

剂量体积参数及CRP与食管癌放疗后放射性肺炎的相关性

目的探讨剂量体积参数及C反应蛋白(CRP)与食管癌放疗后放射性肺炎的相关性。方法回顾性选取食管癌患者76例,经放射治疗后观察食管癌患者放射性肺炎发生情况,分为放射性肺炎组和无放射性肺炎组。收集患者一般资料、临床资料和总剂量、90%计划靶区接受剂量(PTVD_(90)),50 Gy照射计划靶区相应占比(PTVV_(50))、双肺体积、肺剂量体积参数V5~V40、肺平均剂量(MLD)等,检测患者放疗前、放疗一周、放疗后CRP。结果76例食管癌患者放射性肺炎发生率40.79%。临床分期、放疗模式、放疗剂量影响食管癌患者放射治疗后放射性肺炎发生(P<0.05)。食管癌患者放疗一周、放疗后CRP水平高于放疗前,放疗后CRP水平高于放疗一周(P<0.05);放射性肺炎患者放疗一周和放疗后CRP水平均高于无放射性肺炎患者(P<0.05);通过Pearson相关性评估CRP与放射性肺炎之间存在相关性(γ=0.359,P<0.001)。食管PTVD_(90)、食管PTVV_(50)、总剂量、MLD、V5、V10、V15、V20与放射性肺炎发生相关,且为放射性肺炎发生的独立危险因素(P<0.05)。结论放射性肺炎发生与食管癌患者病情严重程度、放射剂量体积参数及CRP水平相关,总剂量、低剂量体积参数是食管癌患者放射性肺炎的危险因素。临床放射治疗计划制定中应注意低剂量体积参数及患者治疗总剂量限制。

Symptomatic Radiation Pneumonitis in NSCLC Patients Receiving EGFR-TKIs and Concurrent Oncedaily Thoracic Radiotherapy:Predicting the Value of Clinical and Dose-volume Histogram Parameters

Background and objectives:The incidence of symptomatic radiation pneumonitis(RP)and its relationship with dose-volume histogram(DVH)parameters in non-small cell lung cancer(NSCLC)patients receiving epidermal growth factor receptortyrosine kinase inhibitors(EGFR-TKIs)and concurrent once-daily thoracic radiotherapy(TRT)remain unclear.We aim to analyze the values of clinical factors and dose-volume histogram(DVH)parameters to predict the risk for symptomatic RP in these patients.Methods:Between 2011 and 2019,we retrospectively analyzed and identified 85 patients who had received EGFR-TKIs and oncedaily TRT simultaneously(EGFR-TKIs group)and 129 patients who had received concurrent chemoradiotherapy(CCRT group).The symptomatic RP was recorded according to the Common Terminology Criteria for Adverse Event(CTCAE)criteria(grade 2 or above).Statistical analyses were performed using SPSS 26.0.Results:In total,the incidences of symptomatic(grade≥2)and severe RP(grade≥3)were 43.5%(37/85)and 16.5%(14/85)in EGFR-TKIs group vs 27.1%(35/129)and 10.1%(13/129)in CCRT group respectively.After 1:1 ratio between EGFR-TKIs group and CCRT group was matched by propensity score matching,chi-square test suggested that the incidence of symptomatic RP in the MATCHED EGFR-TKIs group was higher than that in the matched CCRT group(χ^(2)=4.469,P=0.035).In EGFRTKIs group,univariate and multivariate analyses indicated that the percentage of ipsilateral lung volume receiving≥30 Gy(ilV_(30))[odds ratio(OR):1.163,95%CI:1.036-1.306,P=0.011]and the percentage of total lung volume receiving≥20 Gy(tlV_(20))(OR:1.171,95%CI:1.031-1.330,P=0.015),with chronic obstructive pulmonary disease(COPD)or not(OR:0.158,95%CI:0.041-0.600,P=0.007),were independent predictors of symptomatic RP.Compared to patients with lower iIV_(30)/tlV_(20)values(ilV_(30)and tlV_(20)<cut-off point values)and without COPD,patients with higher ilV_(30)/tlV_(20)values(ilV_(30)and tlV_(20)>cut-off point values)and COPD had a significantly higher risk for developing symptomatic RP,with a hazard ratio(HR)of 1.350(95%CI:1.190-1.531,P<0.001).Conclusion:Patients receiving both EGFR-TKIs and once-daily TRT were more likely to develop symptomatic RP than patients receiving concurrent chemoradiotherapy.The ilV_(30),tlV_(20),and comorbidity of COPD may predict the risk of symptomatic RP among NSCLC patients receiving EGFR-TKIs and conventionally fractionated TRT concurrently.

A missense variant of MASP2 is associated with increased risk of radiation pneumonitis in lung cancer patients treated with radiation therapy

Objective In this study,mannan-binding lectin-associated serine protease 2(MASP2)gene variant was evaluated to assess the risk of radiation pneumonitis(RP)in patients with pulmonary malignancies.Methods A total of 169 lung cancer patients with radiotherapy were included in our prospective study(NCT02490319)and genotyped using the Sanger sequencing method.Multivariate Cox hazards analysis and multiple testing were applied to estimate the hazard ratio(HR)and 95%confidence intervals(CIs)of all factors possibly associated with RP risk.Results Patients with mean lung disease≥15 Gy and V20≥24%had higher risk of RP≥grade 2 compared with their counterparts(HR=1.888,95%CI:1.186-3.004,P=0.007;HR=2.126,95%CI:1.338-3.378,P=0.001,respectively).Importantly,CC+CA genotype of MASP2:rs12711521 was strongly associated with an increased occurrence of RP≥grade 2(HR=1.949,95%CI:1.278-2.971,P=0.002).Conclusion MASP2:rs12711521 was found to be significantly associated with RP≥grade 2 in our cohort and may thus be one of the important predictors of severe RP before radiotherapy,if further validated in larger population.

Bilateral diffuse grade 5 radiation pneumonitis after intensity modulated radiation therapy for localized lung cancer

We are reporting a case of fatal radiation pneumonitis that developed six months following chemoradiation for limited stage small cell lung cancer.The patient was a 67-year-old man with a past medical history of Hashimoto's thyroiditis and remote suspicion for CREST,neither of which were active in the years leading up to treatment.He received 6600 cG y delivered in 200 cG y daily fractions via intensity modulated radiation therapy with concurrent cisplatin/etoposide followed by additional chemotherapy with dosereduced cisplatin/etoposide and carboplatin/etoposide and then received prophylactic cranial irradiation.The subsequent months were notable for progressively worsening episodes of respiratory compromise despite administration of prolonged steroids and he ultimately expired.Imaging demonstrated bilateral interstitial and airspace opacities.Autopsy findings were consistent with pneumonitis secondary to chemoradiation as well as lymphangitic spread of small cell carcinoma.The process was diffuse bilaterally although his radiation was delivered focally to the right lung and mediastinum.

花宝金教授调气解毒理论防治放射性肺炎的临证思路

放射性肺炎是由于辐射之火热毒邪袭肺,导致热毒内盛,气阴两虚,瘀血阻络,气机失调。其中热毒内盛,气机失调是核心病机。花宝金教授基于调气解毒理论,灵活运用清热解毒,益气养阴,活血化瘀,调畅气机等治法,同时注重局部与整体相结合,辨证辨病相结合,在放射性肺炎的预防期未病先防,急性期既病防变,恢复期瘥后防复,为防治放射性肺炎提供了新的临证思路,具有较好的临床价值。

痰热清注射液联合清燥救肺汤立体时相给药治疗放射性肺炎的临床研究

目的:观察痰热清注射液联合清燥救肺汤加减立体时相给药对放射性肺炎(RP)的治疗效果。方法:选择接受胸部三维适形放射治疗,同时中医辨证为痰热阻肺型的肺癌患者100例作为研究对象,随机分为对照组和观察组,每组50例。对照组患者采用单纯放疗,观察组在放疗基础上,给予痰热清静脉注射联合清燥救肺汤加减立体时相给药,于治疗结束后评估2组患者临床疗效及RP发生率,观察2组放疗前、中、后中医证候评分及血清肿瘤坏死因子-α(TNF-α)、转化生长因子-β1(TGF-β1)、白细胞介素-6(IL-6)的水平变化,观察患者放疗前后肺功能指标卡诺夫斯凯计分(KPS)评分的变化。结果:观察组RP发生率较对照组明显降低,临床总有效率明显优于对照组(P<0.05);2组中医证候评分及血清TNF-α、TGF-β1、IL-6水平于放疗后不同时期均明显降低(P<0.05),与对照组比较,观察组放疗后2个月、4个月及放疗结束时中医证候评分及血清TNF-α、TGF-β1、IL-6水平明显降低(P<0.05);观察组肺活量(VC)、用力肺活量(FVC)、第一秒用力呼气量(FEV1)、FEV1/FVC肺功能指标及KPS评分较对照组显著提高(P<0.05)。结论:痰热清注射液联合清燥救肺汤立体时相给药可有效减轻放射治疗所致的放射性肺炎,通过降低血清炎症介质水平,改善肺功能起到减毒增效作用,对提升患者生命质量,提高放疗安全性和有效性具有积极意义。

正常小鼠血清通过抑制focal adhesion信号通路减轻小鼠放射性肺炎

目的探讨正常小鼠血清(NMS)对放射性肺炎的治疗作用及可能机制。方法建立胸腔照射诱导的放射性肺炎模型,将小鼠分为对照组、静脉注射血清组、照射组和照射后静脉注射血清组。注射血清组小鼠在照射后立即静脉注射正常小鼠血清100μL,对照组小鼠注射100μL生理盐水,隔天注射1次,共注射8次。照射后15 d取材,HE染色检测肺组织形态学变化,ELISA检测小鼠肺组织和血清中炎症因子肿瘤坏死因子-α(TNF-α)、转化生长因子-β(TGF-β)、白细胞介素-1α(IL-1α)、白细胞介素-6(IL-6)水平;流式细胞术检测肺组织内淋巴细胞比例变化。外泌体miRNA高通量测序探索处理后小鼠的信号通路变化,qRT-PCR检测免疫相关基因的表达水平,使用Western blotting检测黏着斑通路talin-1、tensin 2、FAK、vinculin、α-actinin和paxillin蛋白的表达。结果与照射组相比,照射后注射血清组小鼠肺脏器系数、血清及肺组织上清液中炎症因子TNF-α、TGF-β、IL-1α、IL-6水平显著降低(P<0.05),CD45^(+)、CD4^(+)、T_(reg)淋巴细胞在小鼠肺组织中的浸润程度显著下降(P<0.05);肺中Egfr和Pik3cd的mRNA和蛋白表达水平显著下调,talin-1、tensin 2、FAK、vinculin、α-actinin和paxillin蛋白的表达水平也显著降低(P<0.05)。结论正常小鼠血清通过抑制focal adhesion信号通路关键蛋白的表达减轻电离辐射诱发的小鼠放射性肺炎。

基于网络药理学的银花甘草汤治疗放射性肺炎的机制

目的:探讨银花甘草汤治疗放射性肺炎的有效成分及其靶点的作用机制。方法:利用TCMSP数据库筛选出银花甘草汤的有效成分及相关靶点蛋白,Uniport数据库对靶点蛋白进行基因标准化处理,结合Genecard数据库中放射性肺炎的疾病靶点进行映射,将筛选得到的中药活性成分和映射得到的作用靶点导入Cytoscape软件中进行活性成分-靶点网络图的构建,并运用Enrich数据库进行GO生物学过程及KEGG信号通路富集分析。结果:获得银花甘草汤有效成分115个,映射得到59个治疗放射性肺炎的靶点,富集到相关生物学过程13个、信号通路61条,山萘酚、木樨草素、β-胡萝卜素、槲皮素等13化合物可能是银花甘草汤治疗放射性肺炎的重要有效成分,PTGS2、NOS2、AKT1、PRARG、MAPK14等5个核心作用靶点是其可能的作用靶点,这些靶点与MAP激酶活性、蛋白丝氨酸/苏氨酸/酪氨酸激酶活性、丝裂原活化蛋白激酶结合、氧化还原酶活性等13条生物过程有关,通过血管内皮生长因子(VEGF)信号通路、小细胞肺癌、C型凝集素受体信号通路、TNF信号通路等61条信号通路进行调节。结论:银花甘草汤对放射性肺炎具有一定的治疗效果,其机制可能通过调节PTGS2、NOS2、AKT1、PRARG、MAPK14等靶点,调控VEGF信号通路、小细胞肺癌、C型凝集素受体信号通路、TNF信号通路等多种途径有关。

血清hsCRP浓度预测非小细胞肺癌放疗后发生急性放射性肺炎的价值

目的评价非小细胞肺癌治疗前血清超敏C反应蛋白浓度(hsCRP)、肺受照射体积剂量参数与急性放射性肺炎发生的关系。方法326例非小细胞肺癌(NSCLC)患者放射治疗前先检测其血清hsCRP浓度,采用调强放疗联合或不联合化疗进行治疗,急性放射性肺炎按照CTC AE 4.0进行评价,≥2级的急性放射性肺炎为研究终点。结果2级及以上急性放射性肺炎患者共64例,占19.0%,放疗前hsCRP浓度低的患者发生放射性肺炎的几率明显降低(9.9%Vs 31.9%,P<0.001);双肺V5>45%、V20>23%、V30>16%和MLD>1300cGy的患者发生急性放射性肺炎的风险比分别为2.16、2.26、2.39和1.97,差异有统计学意义(P<0.05)。结论放疗前血清hsCRP高浓度是急性放射性肺炎的高危因素之一,hsCRP联合放疗计划剂量学参数能够更好的预测肺炎的发生,对于治疗前hsCRP高浓度的NSCLC患者剂量学参数最好能满足V5<36%、V20<17%、V30<13%、MLD<1000 cGy等条件,才能有望将急性放射性肺炎发生几率控制在10%以内。

依帕司他对放射性肺炎小鼠线粒体氧化应激损伤的保护作用

目的:探讨依帕司他(Epa)对放射性肺炎(RP)小鼠线粒体氧化应激损伤的影响及其机制。方法:C57BL/6小鼠随机对照(CON)组、放射(IR)组、IR联合10 mg/kg Epa处理组及IR联合20 mg/kg Epa处理组,每组各16只。采用6MV X线直线加速器全胸单次照射15 Gy建立放射性肺炎模型。照射后连续灌胃给药6~8周。HE染色观察肺组织病理变化。透射电镜观察肺组织线粒体结构。ELISA检测血浆白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)及转化生长因子-β1(TGF-β1)的水平。免疫组化检测肺组织醛糖还原酶(AR)的表达。比色法检测肺组织丙二醛(MDA)及4-羟基壬烯醛(4-HNE)含量。制备肺组织单细胞悬液,使用DCFH-DA探针检测细胞内活性氧(ROS)水平。实时定量PCR检测AR、IL-6、TNF-α和TGF-β1 mRNA的表达。Western blot法检测AR、IL-6、TNF-α、TGF-β1、BAX、Bcl2、Cleaved Caspase-3、8-氧鸟嘌呤DNA糖基化酶1(OGG1)及沉默信号调节因子3(SIRT3)的蛋白水平。结果:与CON组相比,IR组肺泡水肿,肺泡间隔增厚并伴大量炎症细胞浸润;炎症因子IL-6、TNF-α和TGF-β1的水平明显升高(P<0.01);Bcl2的表达明显下调而BAX、Cleaved Caspase-3的表达明显上调(P<0.05,P<0.01)。与IR组相比,Epa连续给药6~8周后,小鼠肺组织炎症损伤明显减轻,炎症因子IL-6、TNF-α和TGF-β1的水平明显降低(P<0.05,P<0.01),细胞凋亡程度明显减轻(Bcl2的表达上调而BAX、Cleaved Caspase-3的表达下调)。与CON组相比,IR组AR的表达明显升高,ROS、MDA及4-HNE的水平明显增加(P<0.01),OGG1和SIRT3的表达明显降低(P<0.01),线粒体损伤明显加剧。而与IR组相比,Epa连续给药6~8周后,IR组AR的表达明显下调(P<0.05,P<0.01),ROS、MDA及4-HNE的水平明显降低,OGG1和SIRT3的表达明显增加,线粒体损伤明显减轻(P<0.05,P<0.01)。结论:Epa对放射性肺炎具有保护作用,其作用可能与其抑制AR的表达,减轻线粒体氧化应激损伤,抑制炎症反应和细胞凋亡有关。

基于约翰霍普金斯循证护理干预在胸部肿瘤放疗致放射性肺炎患者中的应用效果

目的分析基于约翰霍普金斯循证护理干预在胸部肿瘤放疗致放射性肺炎患者中的应用效果。方法选取2022年厦门医学院附属第二医院收治的100例胸部肿瘤放疗并发放射性肺炎患者,采用随机数字表法分为对照组(行常规护理,n=50)和观察组(行基于约翰霍普金斯循证护理,n=50)。比较2组肺功能改善情况[最大呼气中段流量(MMF)、第1秒用力呼气量(FEV1)及第1秒用力呼气量/用力肺活量(FEV1/FVC)],血气指标及炎性因子水平[动脉血二氧化碳分压(PaCO_(2))、血氧分压(PaO_(2))及氧合指数、C-反应蛋白(CRP)];并评估比较2组生活质量[生活质量评价量表(SF-36)]、心理状态[焦虑、抑郁自评量表(SAS、SDS)]、自我感受评价[自我感受负担量表(SPBS)]。结果护理干预后,观察组FVC、FEV1、FEV1/FVC、PEF及PaO_(2)、PaO_(2)/FiO_(2)指标均高于对照组(P<0.05或P<0.001);PaCO_(2)及CRP水平低于对照组(P<0.001)。护理干预后,观察组SF-36各项内容评分均高于对照组(P<0.05);SDS、SAS及SPBS评分均低于对照组(P<0.001)。结论基于约翰霍普金斯循证护理干预在胸部肿瘤放疗致放射性肺炎患者中的应用效果显著,有利于提升患者肺功能,提高其生活质量及治疗依从性,有助病情改善。

加味西洋参百合麦冬汤对放射性肺炎的预防效果及对患者肺功能、血清指标的改善作用研究

目的探究加味西洋参百合麦冬汤对放射性肺炎的预防效果及对患者肺功能、血清指标的改善作用。方法研究纳入100例该院接受胸部放疗治疗的肺癌患者(2019年9月—2022年6月收治),将患者以随机数字表法分为治疗组和对照组,各组50例,对照组患者接受放疗治疗+中药模拟剂治疗,治疗组患者接受放疗治疗+中药加味西洋参百合麦冬汤治疗,比较两组患者放射性肺炎发生率、临床治疗效果、治疗前后患者肺功能指标变化与血清炎症因子水平变化、生活质量量表评分变化及中医证候总积分变化。结果治疗组患者放射性肺炎发生率(0.00%)低于对照组患者(8.00%,4/50),差异有统计学意义(P<0.05);治疗组患者治疗总有效率(94.00%,47/50)比对照组患者(80.00%,40/50)更高,P<0.05;治疗前,两组患者一氧化碳弥散量(DLCO)以及第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)等肺功能指标、血清白细胞介素-6(IL-6)及C反应蛋白(CRP)水平、转化生长因子-β(TGF-β)、生活质量量表评分及中医证候总积分比较,P>0.05,经治疗后各组患者DLCO、FEV_(1)、FVC、IL-6、CRP、TGF-β、生活质量量表评分及中医证候总积分等指标均明显改善,治疗组患者治疗后DLCO、FEV_(1)、FVC、IL-6、CRP、TGF-β、生活质量量表评分及中医证候总积分等指标明显优于对照组,差异有统计学意义(P<0.05)。结论加味西洋参百合麦冬汤可较好预防肺癌放射治疗患者发生放射性肺炎,提升放疗治疗效果,改善患者肺部功能与血清指标,患者症状及生活质量均显著改善,值得应用与深入探讨。

Clinical features, outcomes and treatment-related pneumonitis in elderly patients with esophageal carcinoma

AIM: To investigate the clinical features and prognoses of elderly patients with esophageal carcinoma and to compare the effects of radiotherapy and rates of treatment-related pneumonitis(TRP) between elderly and non-elderly patients.METHODS: A total of 236 patients with esophageal carcinoma who received radiotherapy between 2002 and 2012 were enrolled. The patients were divided into two groups: an elderly group(age ≥ 65 years) and a non-elderly group(age < 65 years). The tumor position and stage, lymph node and distant metastases, and incidence and severity of TRP were compared. Multivariate analysis was applied to identify independent prognostic factors.RESULTS: The median overall survival times after radiotherapy in the elderly and non-elderly groups were 18.5 and 20.5 mo, respectively. Cox regression analysis showed that TRP grade and tumor-node-metastasis (TNM) stage were independent prognostic factors in the elderly group. High-dose radiotherapy(> 60 Gy) was associated with a high incidence of TRP. Tumor TNM staging was significantly different between the two groups in which TRP occurred. Multivariate analysis showed that TNM stage was an independent prognostic factor. Esophageal carcinoma in elderly patients was relatively less malignant compared with that in non-elderly patients.CONCLUSION: An appropriate dose should be used to decrease the incidence of TRP in radiotherapy, and intensity modulated radiation therapy should be selected if possible.

银翘温胆汤对放射性肺炎患者PCT、WBC、CRP水平的影响

目的:探讨银翘温胆汤对放射性肺炎患者降钙素原(PCT)、白细胞(WBC)和C反应蛋白(CRP)水平的影响。方法:选取符合纳入标准的放射性肺炎患者90例随机分为治疗组和对照组,各45例。对照组给予常规西药治疗,治疗组在对照组的基础上加用银翘温胆汤治疗,对比分析两组患者临床有效率、PCT、WBC及CRP水平。结果:治疗组的总有效率为91.1%(41/45),对照组的总有效率为75.6%(34/45),差异有统计学意义(P<0.05)。与治疗前比较,两组患者治疗后PCT、WBC及CRP水平均显著降低(P<0.05),且治疗组优于对照组(P<0.05)。结论:银翘温胆汤能有效降低放射性肺炎患者PCT、WBC及CRP水平,治疗效果优于常规西药治疗,值得推广应用,且PCT、WBC和CRP对放射性肺炎的诊断和治疗具有重要的临床指导价值。

非小细胞肺癌放疗患者发生放射性肺炎的危险因素分析及血清sCD163对RP的诊断价值

目的探讨非小细胞肺癌(NSCLC)放疗患者发生放射性肺炎(RP)的危险因素及血清可溶性清道夫受体分化抗原163(sCD163)对RP的早期诊断价值。方法选取接受放疗的NSCLC患者130例,根据患者有无发生RP将患者分为RP组(n=38)和非RP组(n=92),分析非小细胞肺癌(NSCLC)患者放疗后放射性肺炎(RP)的危险因素,比较2组血清sCD163水平,采用受试者工作特征曲线(ROC)评价血清sCD163对RP的诊断价值。结果单因素分析结果显示:肿瘤大体类型、肿瘤部位、GTV、全肺V5、AVS5、全肺V20、AVS20、MLD与NSCLC患者放疗后发生RP有关(P<0.05);多因素分析结果显示:肿瘤部位、V5、AVS5均是NSCLC患者放疗后发生RP的危险因素(P<0.05)。RP组血清sCD163水平明显高于非RP组(P<0.05)。ROC分析结果显示:血清sCD163诊断NSCLC患者放疗后发生RP的曲线下面积(AUC)为0.852(95%CI:0.763~0.940),灵敏度为80.49%,特异度为63.41%(P<0.001)。结论NSCLC患者放疗后RP发生率较高,导致RP发生的危险因素包括肿瘤部位、V5、AVS5。同时血清sCD163对NSCLC患者放疗后发生RP具有较高的诊断价值。

全段食管癌调强放射治疗7野与8野对称式布野的效果研究

目的研究全段食管癌调强放射治疗计划设计中7野对称式布野与8野对称式布野的靶区及危及器官剂量学特点,为全段食管癌放射治疗患者的计划设计提供一定的参考。方法选择15例全段食管癌放射治疗患者,其中男性8例,女性7例;年龄45~84岁,平均年龄62.5岁;病灶直径(2.8±1.3)cm;病灶长度(14.6±3.7)cm。采用Eclipse计划系统,全组处方剂量均为50 Gy,以95%靶区体积达到100%处方剂量为基准,剂量体积直方图(DVH)比较7野对称式布野与8野对称式布野计划设计方法的主要危及器官的受量。结果靶区均匀性指数(HI),7野对称式布野与8野对称式布野差异无统计学意义(0.55±0.01 vs 0.56±0.01。t=-2.092,P>0.05)。通过比较,全段食管癌调强放射治疗8野对称式布野肺部V_(20)、V_(5)低于7野对称式布野计划[(21.56±3.26)%vs(25.72±1.65)%、(59.60±6.02)%vs(60.48±6.40)%],其他器官差异无统计学意义。结论常规全段食管癌调强放射治疗计划中使用8野对称式布野计划设计方法可有效地减少肺部高剂量区体积,从而进一步减少放射性肺炎的发生率。

肺癌放疗后放射性肺炎患者T淋巴细胞亚群、中性粒细胞与淋巴细胞比值的测定

目的:分析肺癌放疗后放射性肺炎(RP)患者T淋巴细胞亚群、中性粒细胞与淋巴细胞比值(NLR)的变化和意义。方法:选取2018年8月至2022年6月在阜阳市人民医院收治的肺癌调强放射治疗4~8周的患者72例,放疗后6个月内发生RP 11例。收集患者放疗前的一般资料;放疗前,放疗完成后1、2、3个月,检测血液CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞比例,中性粒细胞计数,计算CD4^(+)/CD8^(+)和NLR。结果:RP组KPS评分≥80分患者比例(36.36%)小于未RP组(78.69%),糖尿病患者比例(45.45%)大于未RP组(11.48%),差异均有统计学意义(P<0.05)。与放疗前比较,放疗后两组CD3^(+)、CD4^(+)T淋巴细胞比例及CD4^(+)/CD8^(+)均降低,NLR升高(P<0.05);与未RP组比较,RP组CD3^(+)、CD4^(+)T淋巴细胞比例更低,NLR更高(P<0.05)。结论:KPS评分和糖尿病可能影响肺癌放疗后RP的发生,T细胞亚群、NLR对肺癌放疗后RP的发生可能有预测价值。