非小细胞肺癌适形放射治疗中急性放射性食管炎影响因素的研究  

Clinical and dosimetric risk factors of acute radiation esophagitis in non-small cell lung cancer patients treated with three-dimensional conformal radiotherapy

作　　者：张自成[1] 和劲光[2] 李宝生[1] 尹勇[1] 卢洁[1] 王中堂[1] 李洪升[1] 孙洪福[1] 伊艳[1] 徐瑾[1] 

机构地区：[1]山东省肿瘤医院放疗科山东省放射肿瘤学重点实验室山东省医学科学院,济南250117 [2]菏泽市立医院肿瘤科

出　　处：《中华放射医学与防护杂志》2011年第5期559-563,共5页Chinese Journal of Radiological Medicine and Protection

基　　金：国家自然科学基金（30670617）

摘　　要：目的探讨接受三维适形放疗（3D—CRT）的非小细胞肺癌（NSCLC）患者发生≥2级急性放射性食管炎（ARE）的影响因素。方法回顾102例接受3D—CRT的NSCLC患者的临床资料及三维计划资料，采用RTOG分级标准，评价患者自放疗开始3个月内≥2级的ARE。分析临床因素和三维计划的剂量体积参数。结果发生2级ARE19例，3级15例，未出现更严重的ARE。非同步化疗组多因素回归分析显示，食管％（OR=1．170，P〈0．05）为≥2级ARE发生的惟一影响因素，食管V55的ROC曲线下面积为0．870（95％CI：0．782～0．957，P〈0．05），界值为16．0。同步化疗组多因素回归分析显示，食管匕，（OR=1．125，P〈0．05）和同步化疗方案（OR=39．740，P〈0．05）是≥2级ARE发生的影响因素，食管V35的ROC曲线下面积为0．782（95％CI：0．636～0．927，P〈0．05），界值为23．75。长春瑞滨＋顺铂（NP）同步化疗方案的≥2级ARE发生率明显低于其他方案（33．3％：66．7％）。结论非同步化疗患者，食管虬，是≥2级ARE的影响因素。同步化疗患者，食管‰和同步化疗方案是≥2级ARE的影响因素。同步NP方案≥2级ARE发生率较低。Objective To analyze the clinical and dosimetric risk factors for acute radiation esophagitis （ARE） in non-small cell lung cancer （NSCLC） patients treated with three-dimensional conformal radiotherapy （3D-CRT） , and to find significant risk factors for clinical therapy. Methods A total of 102 NSCLC patients treated with 3D-CRT were retrospectively analyzed. ARE was scored according to the Radiation Therapy Oneology Group （RTOG） criteria with grade 2 or worse. Patients were divided into non-concurrent chemoradiotherapy group and concurrent ehemoradiotherapy group. The clinical and dosimetric factors associated with grade 2 or worse ARE were analyzed using univariate logistic regression, multivariate logistic analysis and receiver operating characteristic （ROC） curve. Results There were no grade 4 or 5 ARE observed in the 102 patients. Nineteen developed grade 2, 15 developed grade 3. In nonconcurrent ehemoradiotherapy group, muhivariate analysis showed that Vss was the only risk factor of grade 2/3 ARE. For ROC curve analysis, the cut-off point of V55 was 16.0 while the area under ROC curve was 0. 870 （95 % CI： 0. 782 -0. 957, P 〈 0.05 ）. In concurrent chemoradiotherapy group, multivariate analysis showed that V35 and chemotherapy regimens during radiotherapy were risk factors of grade 2/3 ARE. The cut-off point of V35 was 23.75 while the area under ROC curve was 0. 782 （95% CI： 0. 636 -0. 927,P 〈 0. 05）. Vinorelbine and cisplatin regimen showed low incidence of ARE contrast with gemcitabine/ docetaxel and eisplatin regimens （33.3% and 66.7% ）. Conclusions Vs5 is the only statistically significant risk factor associated with grade 2 or worse ARE for patients who don＇t accepted concurrent chemotherapy. V35 and chemotherapy regimens during radiotherapy are statistically significant risk factors associated with grade 2 or worse ARE for patients who accept concurrent chemotherapy. Vinorelbine and eisplatin regimen during radiotherapy shows low incidence of ARE.

关 键 词：非小细胞肺癌 三维适形放射治疗 急性放射性食管炎 

分 类 号：R734.2[医药卫生—肿瘤]