心脏低剂量区体积预测49例食管癌术后患者放射性心脏损伤的观察  

Role of low-dose cardiac volume in predicting radiation-induced cardiac injury in patients with esophageal cancer after operation

作　　者：张思洁[1] 沈文斌[2] ZHANG Si-jie;SHEN Wen-bin(bin Fourth Hospitical of Hebei University,Shijiaxhuang 050011,P.R.China)

机构地区：[1]河北医科大学第四医院心内科,河北石家庄050011 [2]河北医科大学第四医院放疗科,河北石家庄050011

出　　处：《中华肿瘤防治杂志》2020年第15期1236-1240,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的近年来在胸部肿瘤的放射治疗中,放射性心脏损伤(radiationinduced heart disease,RIHD)越来越受到临床医师关注,本研究旨在探讨心脏低剂量体积在预测食管癌术后患者RIHD中的作用,为临床治疗计划的制定提供参考。方法回顾性分析2015-01-05-2015-06-30河北医科大学第四医院接受治疗的49例食管癌术后患者临床资料,利用剂量体积直方图记录相关物理指标数值,结合血液检测、物理检查和临床症状判断患者RIHD发生情况,分析不同心脏剂量体积指标与RIHD发生的关系,应用SPSS 19.0软件进行统计分析。结果49例患者出现RIHD 31例(63.3%),其中1级RIHD 28例(23.5%),2级RIHD 3例(6.1%),余18例(39.2%)未出现RIHD。单因素分析结果显示,年龄、心脏体积大小、心脏Max、心脏平均剂量(mean heart dose,MHD)、心脏V5~V35,心脏D20~D80和照射野数目均影响RIHD的发生,P<0.05。多因素分析结果显示,MHD(OR=1.008,95%CI:1.001~1.016)和心脏V20(OR=1.985,95%CI:1.231~3.200)是影响RIHD发生的独立性危险因素。ROC曲线分析结果显示,心脏V20和MHD最佳分界值分别为63.21%和2675.75cGy时,以此界值进行分组比较发现数值较大组患者RIHD发生率(81.3%vs29.4%,86.7%vs 26.3%)均高于数值较低组,χ2值分别为12.837、18.231,均P<0.001。结论心脏V20和MHD为食管癌术后接受新辅助放化疗患者出现RIHD的独立性预测影响因素,临床制定治疗计划时应充分考虑2种参数对患者长期生活质量的影响。OBJECTIVE In recent years,radiation-induced cardiac injury(RIHD)has attracted more and more attention from clinicians in the radiotherapy of chest tumors.The purpose of this paper was to investigate the role of low-dose cardiac volume in predicting RIHD in patients with esophageal cancer after surgery,and to provide reference for clinical treatment plan.METHODS A retrospective analysis was made on 49patients with esophageal cancer who were treated in the Fourth Hospital of Hebei Medical University from January 5,2015to June 30,2015.Dose volume histogram was used to record the values of relevant physical indicators,and combined with blood testing,physical persistence and clinical symptoms to judge the occurrence of RIHD.The relationship between different cardiac dose volume indexes and RIHD occurrence was analyzed by SPSS19.0 software.RESULTS Of the 49 patients,31(63.3%)had RIHD,of which28(23.5%)had grade 1RIHD,3(6.1%)had grade 2RIHD,and 18(39.2%)had no symptoms of RIHD.Univariate analysis showed that age,cardiac volume,cardiac Max,MHD,V5-V35,cardiac D20-D80 and the number of radiation fields all affected the occurrence of RIHD(P<0.05).Multivariate analysis showed that MHD(OR=1.008,95%CI:1.001-1.016)and V20(OR=1.985,95%CI:1.231-3.200)were independent factors influencing RIHD.ROC curve analysis showed that the optimal dividing values of V20 and MHD were 63.21%and 2675.75cGy,respectively.The incidence of RIHD in patients with larger values(81.3%vs 29.4%,86.7%vs 26.3%)was significantly higher than that in patients with lower values(χ2 values were 12.837and 18.231,both P<0.001).CONCLUSION Cardiac V20 and MHD are independent predictors of RIHD in patients receiving adjuvant neoradiotherapy and chemotherapy after esophageal cancer surgery.The effects of these two parameters on long-term quality of life should be fully considered in clinical treatment planning.

关 键 词：食管肿瘤 术后辅助放化疗 心脏损伤 低剂量体积 

分 类 号：R735.1[医药卫生—肿瘤]