食管癌根治切除术后辅助调强放疗胸腔胃照射剂量与急性放射性胸腔胃炎的关系  

The relationship between the dose-volume indexes and acute toxicity of intrathoracic stomach in esophageal cancer patients receiving radiotherapy after esophagectomy

作　　者：宋春洋[1] 祝淑钗[1] 沈文斌[1] 苏景伟[1] 高丝娜 赵彦[1] 许金蕊 李曙光[1] Song Chunyang;Zhu Shuchai;Shen Wenbin;Su Jingwei;Gao Sina;Zhao Yan;Xu Jinrui;Li Shuguang(Department of Radiation Oncology,The Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Nephrology,The Third hospital of Shijiazhuang,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011 [2]石家庄市第三医院肾内科,050011

出　　处：《中华放射医学与防护杂志》2020年第2期106-111,共6页Chinese Journal of Radiological Medicine and Protection

基　　金：河北省医学科学研究重点课题计划(20170758)。

摘　　要：目的研究食管癌术后调强放疗剂量学与胸腔胃放射性损伤的关系。方法通过入组104例食管癌根治术后行调强放疗的患者,对其临床资料及放疗计划中胸腔胃剂量-体积参数与急性放射性胸腔胃炎的发生情况进行分析,ROC曲线分析与急性放射性胃炎发生可能相关的物理学指标,logistic法行单因素及多因素分析。结果全组104例患者出现≥2级急性放射性胸腔胃炎者29例(27.88%)。与≥2级急性放射性胸腔胃炎相关的剂量-体积指标包括:胸腔胃Dmax、Dmean、L5~L45、V5~V50。单因素分析显示,胸腔胃位置、胸腔胃Dmax、Dmean、胸腔胃L5~L45和V5~V50均与≥2级急性放射性胸腔胃炎的发生显著相关(P<0.05);多因素分析显示,胸腔胃位置、L5、V35与≥2级急性放射性胸腔胃炎的发生均显著相关(P<0.05)。ROC曲线所得L5及V35的最佳界值分别为14.00 cm和44.00%,胸腔胃L5≥14.00 cm和L5<14.00 cm发生≥2级急性放射性胸腔胃炎的概率分别为38.64%和20.00%(χ^2=4.473,P<0.05);V35≥44.00%和V35<44.00%发生≥2级急性放射胸腔胃炎的概率分别为57.58%和14.08%(χ^2=7.263,P<0.05)。后纵隔胃患者≥2级急性放射性胸腔胃炎的发生率显著高于其他两组(χ^2=12.881,P<0.05)。结论胸腔胃剂量-体积参数对急性放射性胸腔胃炎的发生具有一定的预测价值,建议对术后需行放疗的食管癌患者慎重选择后纵隔胸腔胃手术方案。Objective To study the relationship between the dose-volume indexes and acute toxicity of intrathoracic stomach in esophageal cancer patients receiving radiotherapy after esophagectomy.Methods A total of 104 patients treated with postoperative radiotherapy followed by radical esophagectomy were enrolled.The dose-volume indexes of intrathoracic stomach were collected from treatment planning system.The ROC curve and logistic regression were performed to analyze the relationship between acute toxicity of intrathoracic stomach and clinical parameters,dose-volume indexes.Results A total of 29 patients(27.88%)suffered from grade 2 or above acute toxicity.The ROC curve analysis showed that the dose-volume indexes including Dmax,Dmean,L5-L45 and V5-V50were associated with occurrence of grade 2 or above acute toxicity.The univariate analysis showed that location,Dmax,Dmean,L5-L45 and V5-V50 were significantly correlated with the incidence of grade 2 or above acute toxicity(P<0.05).The multivariate analysis showed that location,L5 and V35 were independent factors for incidence of grade 2 or above acute toxicity.The ROC curve analysis showed that cut-off values of L5 and V35 were 14.00 cm and 44.00%,respectively.And the rates of Grade 2 or above acute toxicity were 20.00%for L5>14.00 cm and 38.64%for L5≥14.00 cm(χ^2=4.473,P<0.05),14.08%for V35<44.00%and 57.58%for V35≥44.00%(χ^2=7.263,P<0.05),respectively.The incidence of grade 2 or above acute toxicity was significantly higher in post-mediastinum stomach group than the other two groups(χ^2=12.881,P<0.05).Conclusions Dosevolume index may be indicator to predict acute toxicity of intrathoracic stomach.It is recommended that post-mediastinum stomach should be chosen carefully if esophageal cancer patients require postoperative radiotherapy.

关 键 词：食管癌 手术治疗 放射性胸腔胃炎 剂量-体积参数 

分 类 号：R735[医药卫生—肿瘤]