调强放疗致肺癌患者急性放射性食管炎影响因素分析  

Analysis of Factors Affecting Acute Radiation Esophagitis in Patients with Lung Cancer Due to Intensity-Modulated Radiotherapy

作　　者：何佳欣 朱小辉 奚和明 王小翠 金秀 赵小静[1] HE Jiaxin;ZHU Xiaohui;XI Heming;WANG Xiaocui;JIN Xiu;ZHAO Xiaojing(Radiotherapy Department Anyang People’s Hospital)

机构地区：[1]安阳市人民医院放疗科,河南安阳455000 [2]安阳市人民医院结直肠肛门外科

出　　处：《长治医学院学报》2024年第5期358-362,共5页Journal of Changzhi Medical College

摘　　要：目的:分析影响肺癌患者调强放疗后急性放射性食管炎发生的危险因素。方法:回顾性分析80例Ⅱb~Ⅳ期肺癌患者临床资料,行调强放疗,总照射量60~66 Gy。同步化疗47例、靶向治疗15例,采用RTOG急性放射性损伤的分级标准,观察发生急性放射性食管炎的分级情况,比较发生和未发生急性放射性食管炎患者的临床相关资料,利用多因素Logistic回归分析急性放射性食管炎发生的独立危险因素。结果:本组80例完成调强放疗计划周期后,有48例患者出现急性放射性食管炎,其中1级40例,2级4例,3级2例,4级2例;急性放射性食管炎发生率为60.00%;急性放射性食管炎患者年龄≥60岁、Ⅲb~Ⅳ期、存在同步化疗、靶向治疗、有糖尿病、食管照射长度>10 cm占比均高于未发生放射性食管炎的患者(P<0.05),且急性放射性食管炎患者的食管照射总剂量、平均剂量、体积百分比V20、V30、V40、V50均高于未发生放射性食管炎患者(P<0.05);多因素Logistic回归分析结果显示,有同步化疗(OR=40.005)、同步靶向治疗(OR=42.479)、食管照射平均剂量高(OR=63.688)、V20(OR=52.300)、V30(OR=36.525)、V40(OR=40.366)、V50(OR=47.276)高是影响肺癌患者调强放疗后急性放射性食管炎发生的独立危险因素(P<0.05)。结论:有同步化疗、同步靶向治疗、食管照射平均剂量高、V20、V30、V40、V50高为影响肺癌患者调强放疗后急性放射性食管炎发生的独立危险因素,临床在制定放疗方案时,应根据患者的实际情况,结合不同的分割方案来制定治疗计划,避免出现过度损伤食管的情况。Objective:To analyze the risk factors of acute radiation esophagitis after intensity modulated radiotherapy in patients with lung cancer.Methods:The clinical data of 80 patients with stageⅡb~Ⅳlung cancer were retrospectively analyzed.Intensity modulated radiotherapy was performed with a total irradiation dose of 60~66 Gy.47 patients were treated with synchronous chemotherapy,and 15 patients were treated with synchronous targeted therapy.The grading of acute radiation esophagitis was observed using the grading standard of RTOG acute radiation injury,and the clinical data of patients with acute radiation esophagitis and patients without acute radiation esophagitis were compared.Multivariate Logistic regression was used to analyze the independent risk factors for acute radiation esophagitis.Results:After 80 patients completed the planned period of IMRT,48 patients developed acute radiation esophagitis,including 40 cases of grade 1,4 cases of grade 2,2 cases of grade 3,and 2 cases of grade 4.The incidence of acute radiation esophagitis was 60.00%.The proportion of patients with acute radiation esophagitis whose age was≥60 years,stageⅢb~Ⅳ,concurrent chemotherapy,targeted treatment,diabetes mellitus,and esophageal radiation length>10cm were higher than those without radiation esophagitis(P<0.05),and the total dose,average dose,and volume percentage of esophageal radiation in patients with acute radiation esophagitis(Volume,V)V20,V30,V40 and V50 were higher than those in patients without radiation esophagitis(P<0.05).The results of multivariate logistic regression analysis showed that synchronous chemotherapy(OR=40.005),synchronous targeted therapy(OR=42.479),high average dose of esophageal radiation(OR=63.688),V20(OR=52.300),V30(OR=36.525),V40(OR=40.366),and V50(OR=47.276)were independent risk factors for the occurrence of acute radiation esophagitis in lung cancer patients after intensity modulated radiotherapy(IMRT)(P<0.05).Conclusion:Synchronous chemotherapy,synchronous targeted therapy,high average dose o

关 键 词：调强放疗 肺癌 放射性食管炎 相关因素分析 

分 类 号：R818[医药卫生—放射医学]