食管癌调强放疗并同步化疗后的初期疗效分析及发生急性放射性肺损伤的危险因素研究  

Initial efficacy analysis and risk factors of acute radiation-induced lung injury after intensity-modulated radiotherapy combined with chemotherapy for esophageal cancer

作　　者：汪瑞 魏本飞 WANG Rui;WEI Benfei(Department of Oncology,Affiliated Hospital of Yangzhou University,Jiangsu,Yangzhou 225000,China)

机构地区：[1]扬州大学附属医院肿瘤科,江苏扬州225000

出　　处：《中国现代医生》2022年第27期71-75,共5页China Modern Doctor

摘　　要：目的分析食管癌调强放疗(intensity-modulated radiation therapy,IMRT)并同步化疗后的初期疗效及发生急性放射性肺损伤情况,进一步探讨急性放射性肺损伤的相关危险因素。方法选取2020年1月至2021年5月扬州大学附属医院肿瘤科收治的96例食管癌患者,均接受IMRT并同步FP(5-氟尿嘧啶+顺铂)方案化疗,回顾性收集其一般资料。根据美国肿瘤放射治疗协作组(Radiation Therapy Oncology Group,RTOG)急性放射性肺损伤分级标准分为急性放射性肺损伤组(1~4级,25例)和无急性放射性肺损伤组(0级,71例),分析食管癌患者IMRT后的初期疗效及急性放射性肺损伤发生状况,通过单因素分析及多因素Logistic回归分析食管癌患者IMRT后急性放射性肺损伤发生的相关危险因素。结果食管癌患者IMRT并同步化疗初期疾病控制率为71.88%(69/96),96例食管癌患者IMRT后急性放射性肺损伤发生25例,急性放射性肺损伤发生率26.04%。多因素Logistic回归分析结果显示,淋巴结转移、卡氏评分70~80分、合并基础肺部疾病、计划靶区体积≥36.7cm^(3)、全肺平均剂量≥10Gy是食管癌患者IMRT后急性放射性肺损伤发生的危险因素(OR=2.261,1.976,2.190,4.141,2.450,P<0.05)。结论食管癌IMRT并同步化疗后的初期疗效好,但急性放射性肺损伤发生风险较高;食管癌IMRT后急性放射性肺损伤的发生与淋巴结转移、卡氏评分70~80分、合并基础肺部疾病、计划靶区体积≥36.7cm^(3)、全肺平均剂量≥10Gy等多种因素有关,临床可据此进行针对性干预,进而降低食管癌IMRT并同步化疗后和急性放射性肺损伤发生率。Objective To analyze the initial efficacy of intensity-modulated radiation therapy(IMRT)combined with chemotherapy for esophageal cancer and the incidence of acute radiation-induced lung injury,and to further study the risk factors of acute radiation-induced lung injury.Methods A total of 96 patients with esophageal cancer admitted to the Department of Oncology,affiliated Hospital of Yangzhou University from January 2020 to May 2021 were enrolled in this study.All patients received IMRT combined with FP(5-fluorouracil+cisplatin)regimen chemotherapy,and their general data were retrospectively collected.The patients were divided into acute radiation-induced lung injury group(grade 1-4,25 cases)and non-acute radiation-induced lung injury group(grade 0,71 cases)according to the severity of acute radiation-induced lung injury(RTOG).The initial efficacy of esophageal cancer patients after IMRT and the occurrence of acute radiation-induced lung injury in esophageal cancer patients after IMRT were analyzed.Univariate analysis and multivariate Logistic regression were used to analyze the risk factors of acute radiation-induced lung injury in patients with esophageal cancer after intensity-modulated radiotherapy.Results The initial disease control rate of esophageal cancer patients with IMRT combined with chemotherapy was 71.88%(69/96).Acute radiation-induced lung injury occurred in 25 of 96 patients with esophageal cancer after IMRT,and the incidence rate of acute radiation-induced lung injury was 26.04%.The results of multivariate logistic regression analysis showed that lymph node metastasis,carver score of 70-80,combined with underlying pulmonary disease,planning target volume≥36.7cm^(3),mean lung dose≥10Gy was a risk factor for acute radiation-induced lung injury in patients with esophageal cancer after IMRT(OR=2.261,1.976,2.190,4.141,2.450,P<0.05).Conclusion The initial efficacy of intensity-modulated radiotherapy combined with chemotherapy for esophageal cancer is good,but the risk of acute radiation-induced lun

关 键 词：食管癌 调强放射治疗 急性放射性肺损伤 初期疗效 危险因素 

分 类 号：R735[医药卫生—肿瘤]