摘要
目的 分析胸中下段食管癌患者三维适形放疗后导致放射性肺损伤的临床、物理因素。方法选取56例接受根治性放疗的食管癌患者密切随访。以患者临床症状、胸部X线片、CT、薄层CT了解患者有无急性放射性肺炎及晚期放射性肺损伤发生，对患者临床资料和治疗计划等指标进行单因素及多因素分析，评价放射性肺损伤。结果 单因素分析显示X线片食管病变长度、处方剂量、肺V5-V25笛、肺Dmean、食管PTVD90、食管PTVV50及总射野数等11个因素与急性放射性肺炎发生相关，且其数值在有无发生急性放射性肺炎两组中有差异；X线片食管病变长度、肺V5-V40、肺Dmean及合并化疗与晚期放射性肺损伤相关，且其数值在有无发生晚期肺损伤的两组患者中亦有差异。Logistic多元回归分析显示肺V25、总射野数和X线片病变长度为急性放射性肺炎发生的独立影响因素，而肺V30和合并化疗为晚期放射性肺损伤发生的独立影响因素。急性放射性肺炎与晚期放射性肺损伤发生未见明显相关性。急性放射性肺炎、晚期放射性肺损伤对近期生存率未见明显影响。结论食管癌患者肺V25、总射野数及X线片食管病变长度可预测急性放射性肺炎的发生，肺V30和合并化疗为影响晚期放射性肺损伤发生的主要因素。
Objective To evaluate the clinical and dosimetric predictors of acute and late lung toxicity in patients with thoracic middle and lower esophageal cancer treated with three-dimensional conformal radiotherapy（3DCRT）. Methods Sixty-five patients with the said esophageal cancer treated by 3DCRT were included in this study. Clinical symptoms, chest X-ray, CT and HRCT scan were used to detect the acute radiation pneumonitis and the late radiation lung toxicities. The clinical factors and treatment parameters were collected and coded. All factors correlating with acute and late lung toxicity were analyzed. Results 1. Univariate analysis showed that the primitive tumor length, prescription dose, lung V5-V25 ,lung Dmean esophageal PTVD90, esophageal PTVV50 and radiation fields were factors causing acute radiation pneumonitis. The magnitude of these values was significantly different between patients with and without radiation pneumonitis. The primary tumor length, lung V5-V40,lung Dmean and combined chemotherapy had a significant relationship with the late radiation lung toxicities. The magnitude of these values were also significantly different in patients with and without late radiation lung toxicities. 2. Binary Logistic regression analysis showed that lung V25, the primary tumor length and the radiation fields were the independent risk fractors of acute radiation pneumonitis. Lung V30 and combined chemotherapy were independent risk factors of late radiation lung toxicity. 3. There were no relation between acute radiation pneumonitis or late radiation lung toxicities. 4. There were no relation between the survival rate and acute radiation pneumonitis or late radiation lung toxicities. Conclusions In thoracic middle and lower esophageal cancer patients treated with 3DCRT, lung V25, primitive tumor length and radiation fields were significantly associated with a risk of acute radiation pneumonitis. Lung V30 and combined chemotherapy were independent risk factors of late radiation lung toxiciies.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2007年第5期335-340,共6页
Chinese Journal of Radiation Oncology
关键词
食管肿瘤/三维适形放射疗法
放射性肺损伤
因素分析
Eesophageal neoplasms/three-dimensional conformal radiotherapy
Radiation-induced lung injury
Factor analysis
