肺癌三维适形放射治疗中肺和食管损伤的相关因素分析  

Factors predicting radiation toxicity in the treatment of three-dimensional conformal radiotherapy for lung cancer

作　　者：王颖杰[1] 王绿化[1] 冯勤付[1] 陈东福[1] 张宏兴[1] 肖泽芬[1] 周宗玫[1] 欧广飞[1] 赵路军[1] 章众[1] 张可[1] 殷蔚伯[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院放射治疗科,北京100021

出　　处：《中国肺癌杂志》2005年第5期454-458,共5页Chinese Journal of Lung Cancer

基　　金：首都医学发展科研基金(N0.20021016)资助~~

摘　　要：背景与目的在胸部肿瘤的放射治疗中,肺、食管等正常组织往往会受到一定剂量的照射,造成不同程度的放射损伤。本研究拟分析肺癌三维适形放射治疗中放射性食管和肺损伤的发生率及其相关因素。方法收集1999年3月至2003年9月首程行三维适形放疗的肺癌病例,总计112例,男87例,女25例,中位年龄64岁(20～87岁)。其中非小细胞肺癌97例,小细胞肺癌15例。放疗中位单次剂量2Gy,每周5次,中位总剂量60Gy。结果2级以上急性放射性肺损伤为7.1%(8/112);2级以上晚期放射性肺损伤为1.8%(2/112);2级急性放射性食管损伤8.9%(10/112)。单因素和多因素分析均未发现与急性放射性肺损伤相关的临床因素和物理因素。单因素分析显示,疗前体重下降≥5%和行化疗或同时化放疗的病例,急性放射性食管损伤的发生率升高,统计学分析均有显著性差异,其中疗前体重下降≥5%在多因素分析中也有统计学意义(P=0.016)。结论此研究未能发现与急性放射性肺损伤相关的临床因素和物理因素,但发现与急性放射性食管损伤相关的因素是疗前体重下降≥5%。Background and objective The lung and esophagus are always damaged during radiation on thoracic tumors to a certain extent. This study is to report the incidence of radiation pneumonitis and radiation esophagitis and to analyze the factors as predictors of radiation toxicity in the treatment of three-dimensional conformal radiotherapy （3DCRT） for lung cancer. Methods Between March 1999 and September 2003, 112 lung cancer patients treated with 3DCRT were reviewed at this Hospital. This population consisted of 87 men and 25 women, including 97 cases of non-small cell lung cancer and 15 of small cell lung cancer. The median age was 64 years old. Radiotherapy was delivered at 2 Gy fraction, 5 fractions per week. The median total dose was 60 Gy. Results Grade 2 or more acute radiation pneumonitis developed in 7.1% （8/112） of patients while grade 2 or more late radiation pneumonitis appeared in 1.8% （2/112） of patients. Acute radiation esophagitis was observed in 8. 9% （10/112） of patients with grade 2. No clinical and physical factor was relative to acute radiation pneumonitis by univariate and multivariate analysis. In the entire population, the univariate analysis revealed that many parameters （pre-treatment weight loss more than 5 %, chemotherapy and concurrent chemotherapy） were significantly associated with acute radiation esophagitis. Multivariate analysis revealed that pretreatment weight loss more than 5% was the most important risk factor for acute radiation esophagitis （.P=0. 016）. Conclusion No clinical and physical factor is relative to acute radiation pneumonitis and pre-treatment weight loss more than 5% is the most important risk factor for acute radiation esophagitis in this study.

关 键 词：肺肿瘤 放射疗法/适形放射疗法 放射性肺损伤 放射性食管损伤 

分 类 号：R734.2[医药卫生—肿瘤]