深部热疗对老年食管癌调强放疗患者放射性肺炎的影响  

Effect of hyperthermia on radiation pneumonitis in elderly patients with esophageal cancer receiving intensity-modulated radiation therapy

作　　者：王梦姣 陈胜东 朱国民 焦旸[3] 周菊英[1] 秦颂兵[1] 王利利[1] Wang Mengjiao;Chen Shengdong;Zhu Guomin;Jiao Yang;Zhou Juying;Qin Songbing;Wang Lili(Department of Radiation Oncology,First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Radiation Oncology,Yixing Cancer Hospital,Wuxi 214200,China;School of Radiation Medicine and Protection,Medical College of Soochow University,Suzhou 215123,China)

机构地区：[1]苏州大学附属第一医院放疗科,苏州215006 [2]宜兴市肿瘤医院放疗科,无锡214200 [3]苏州大学苏州医学院放射医学与防护学院,苏州215123

出　　处：《中华放射肿瘤学杂志》2024年第3期218-225,共8页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金面上项目(82073476);国家重点研发计划(2022YFC2503700,2022YFC2503703);江苏省医学重点学科(ZDXK202235)。

摘　　要：目的探讨深部热疗对老年食管癌调强放疗患者发生放射性肺炎情况的影响。方法回顾性分析2017年8月1日—2023年2月6日在苏州大学附属第一医院、宜兴市肿瘤医院接受调强放疗的177例老年(≥60岁)食管癌患者,根据患者是否行深部热疗分为热疗组和非热疗组。两组均采用6 MV X射线常规调强放疗,热疗组在放疗前1 h内使用体外热疗设备HG-2000Ⅲ进行高频深部热疗,每周2次,加热温度为41~43℃,时间为40 min。通过倾向评分匹配校正组间混杂因素后,采用χ2检验比较两组患者的近期有效率;单因素分析及logistic多因素分析比较两组患者放射性肺炎的发生情况。结果倾向评分匹配后两组各42例患者,匹配后两组患者基线资料及放疗剂量参数的差异均无统计学意义(P>0.05)。热疗组客观缓解率显著高于非热疗组(83.3%∶64.3%,P=0.047)。单因素分析结果显示,热疗组发生放射性肺炎、症状性(≥2级)放射性肺炎概率均显著小于非热疗组(61.9%∶85.7%,P=0.013;21.4%∶47.6%,P=0.012)。logistic多因素分析结果显示,热疗是症状性放射性肺炎的独立保护因素(P=0.011)。结论老年食管癌患者调强放疗期间使用深部热疗不仅能提高肿瘤治疗效果,还能降低放射性肺炎的发生率及严重程度。Objective To evaluate the effect of hyperthermia on radiation pneumonitis(RP)in elderly patients with esophageal cancer undergoing intensity-modulated radiotherapy(IMRT).Methods Clinical data of 177 elderly esophageal cancer patients(aged≥60 years)receiving IMRT in the First Affiliated Hospital of Soochow University and Yixing Cancer Hospital from August 1,2017 to February 6,2023 were retrospectively analyzed.Patients were divided into the hyperthermia and non-hyperthermia groups based on whether they received hyperthermia treatment.Patients in two groups received IMRT with 6 MV X-rays.Patients in the hyperthermia group underwent high-frequency hyperthermia within 1 h before radiation using the external thermotherapy device HG-2000Ⅲ(heating temperature:41-43℃for 40 min,twice a week).After adjusting for confounding factors between two groups using propensity score matching(PSM),the short-term effective rates between two groups were compared using Chi-square test.Univariate analysis and logistic multivariate analysis were employed to compare the incidence of RP between two groups.Results After applying PSM,42 pairs were successfully matched,and the baseline data and radiotherapy parameters showed no statistically significant differences between two groups(all P>0.05).The objective response rate(ORR)in the hyperthermia group was significantly higher than that in the non-hyperthermia group(83.3%vs.64.3%,P=0.047).Univariate analysis revealed that the incidence of RP and symptomatic RP(≥grade 2)in the hyperthermia group was significantly lower than that in the non-hyperthermia group(61.9%vs.85.7%,P=0.013;21.4%vs.47.6%,P=0.012).Logistic multivariate analysis indicated that hyperthermia was an independent protective factor for symptomatic RP(P=0.011).Conclusions The incidence and severity of RP in elderly esophageal cancer patients receiving IMRT can be reduced by hyperthermia.Hyperthermia,as a clinically beneficial green treatment,improves efficacy and reduces toxicity for patients with esophageal cancer.

关 键 词：放射疗法 热疗 放射性肺炎 食管肿瘤 倾向评分匹配 

分 类 号：R735.1[医药卫生—肿瘤] R818[医药卫生—临床医学]