Ⅲ期非小细胞肺癌同步放化疗所致急性食管损伤研究  

Acute esophageal toxicities in patients with stage Ⅲ non-small cell lung cancer treated by three-dimensional conformal radiotherapy combined with concurrent chemotherapy

作　　者：王澜[1] 张彬[2] 韩春[1] 吕冬婕[1] 李晓宁[1] 高超[1] 

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011 [2]上海复旦大学附属金山医院放疗科,200540

出　　处：《中华放射肿瘤学杂志》2009年第6期458-462,共5页Chinese Journal of Radiation Oncology

基　　金：河北省强势特色学科课题资助（冀教高[2005]52号）

摘　　要：目的观察三维适形放疗（3DCRT）联合长春瑞滨＋顺铂（NP）同步化疗Ⅲ期非小细胞肺癌（NSCLC）的急性放射性食管炎发生情况，并对相关因素进行分析，以求得到合理的预测性指标。方法37例Ⅲ期NSCLC患者接受3DCRT及NP方案同步化疗，放疗处方剂量60Gy，1．8—2．0Gy／次，5次／周，共30～34次，于放疗开始的第1、5周给予同步化疗，观察急性放射性食管炎发生情况并进行相关因素及受试者工作特征（ROC）曲线分析。结果全组食管炎总发生率为92％（34例），其中0级3例，1级11例，2级9例，3级14例，无4级发生。单因素分析显示食管接受的平均剂量、LETT40、LETT45、LETT50、LETT55、LETT60、V40、V45、V50、V55、V60均与放射性食管炎具有较好相关性，能预测急性放射性食管炎发生；多因素分析结果提示食管V55是预测放射性食管炎的最有价值的指标。ROC曲线分析结果示曲线下面积为0．906（P=0．000），曲线界值V55=30％；食管V55〉30％组与≤30％组≥2级放射性食管炎发生率分别为100％（15／15）和36％（8／22）。结论对局部晚期NSCLC进行3DCRT结合同步化疗可出现较严重放射性食管炎，食管接受的平均剂量、LETT40、LETT45、LETT50、LETT55、LETT60、V40、V45、V50、V55、V60可较好预测放射性食管炎的发生，V55可能是最有价值的预测性指标，当V55〉30％时2、3级急性放射性食管炎的发生率可能会明显增加。Objective To investigate the radiation-induced esophageal toxicities in Ill stage nonsmall cell lung cancer （NSCLC） treated by three-dimensional conformal radiotherapy （3DCRT） combined with concurrent chemotherapy, and to find the relevant predictive factors. Methods From September 2006 to October 2007, 37 patients with stage Ⅲ NSCLC were treated by 3DCRT （60 Gy in 30 - 34 fractions） concurrently with navelbine and cisplatin （NP）. Chemotherapy was given in the first and fifth week. Univariate and multivariate analyses and receiver operating characteristic curves （ROC） were used to assess the association of radiation-induced esophagitis and correlated factors. Results Of all the patients, 91.89% （34/37） developed radiation-induced esophagitis, including grade 1 in 11 patients, grade 2 in 9, grade 3 in 14 and grade 4 in none. According to Spearman correlative analysis, the correlative factors included mean esophagus dose （ MED）, the LETr40, LETT45, LETT50, LETT55, LETT60, V40, V45, V50, V55 and V60 of esophagus. All the 11 factors had good correlation with esophagitis in univariate analysis, while only V55 was independently associated with esophagitis in multivariate analysis. The ROC analysis indicated that the cut-off point of the curve was 30% with the area under ROC curve of 0. 906, （P = 0.000）. Grade 2 or 3 radiation esophagitis occurred in all the patients with esophageal V55 〉 30%, while only in 36% （8/22） of those with V55 ≤ 30%. Conclusions 3DCRT combined with concurrent chemotherapy in patients with stage Ⅲ NSCLC could develop severe esophagitis. Dosimetric parameters （MED, LETF40, LETT45, LETrso, LETT55, LETT60, V40, V45, V50, V55 and V60 ） are related with esophagitis, with V55 〉 30% being the most valuable predictor.

关 键 词：肺肿瘤/放化疗法 放射疗法 三维适形 放化疗法 同步 放射性食管炎 

分 类 号：R686[医药卫生—骨科学]