摘要
目的观察食管癌三维适形放疗中肺及食管损伤情况，对其相关因素进行分析，寻找合理的预测性指标。方法44例首程治疗的食管癌患者接受三维适形放疗，全组处方剂量58～70 Gy，中位处方剂量66 Cy，24例行常规分割放疗，余20例行后程加速照射，即常规分割照射30～40 Gy/3～4周后再加速照射，3 Gy/次，1次/d，5次/周。对三维适形计划及患者临床资料进行单因素、多因素分析，评价肺及食管损伤。结果（1）全组患者完全缓解33例，部分缓解10例，总有效率为98%（33/44），1年总生存率为69%。（2）全组急性放射性肺炎0级20例（45%），1级15例（34%），2级7例（16%），3级2例（5%），未见4级；后程加速照射组1级放射性肺炎发生率似高于常规照射组但差异无统计学意义（45%：25%，P=0．163）。与放射性肺炎发生相关的剂量学因素包括全肺平均剂量，肺NTCP，肺V（20）、V（30）、V（30）、V（35）。临床资料中仅GTV体积与放射性肺炎发生相关；多因素分析显示全肺平均剂量为放射性肺炎发生的独立影响因素。（3）全组急性放射性食管炎0级1例（2%），1级24例（55％），2级15例（34％），3级4例（9％），未见4级；后程加速照射组2、3级食管炎发生率似高于常规照射组但差异也无统计学意义。结论剂量学因素（全肺平均剂量（MLD），肺NTCP，肺V20、V25、V30、V35）可以较好地预测放射性肺炎的发生，全肺平均剂量是放射性肺炎的独立影响因素，后程加速照射有可能加重食管的急性期反应，但对放射性肺炎的发生无明显影响。
Objective To observe the toxicity in the lung and esophagus induced by three dimensional conformal radiation therapy （3DCRT） in patients with esophageal carcinoma and analyze the correlative factors as reasonable predictors. Methods Between July 2003 and October 2004, 44 untreated esophagcal carcinoma patients received 3DCRT, with a median prescription dose of 66 Gy（range, 58～70 Gy）. Twenty-four patients received conventional fractionated radiation and 20 patients who received conventional fractionated radiation during the first 3-4 weeks to the 4th or 5th week, received accelerated radiation, 3 Gy/per fraction, 1 fraction/per day, 5 fractions/per week. Univariate and multivariate analysis were performed to test the association between radiation pneumonitis（RP）, esophagitis and the dosimetric and clinical factoes. Results 1. Thirty-three patients showed complete remission（CR）, 10 patients partial remission （PR）, with an overall response rate of 98% （43/44） and the 1-year survival of 69%, 2. Of these 44 patients, 24 （55%） developed radiation pneumonitis（RP）： grade Ⅰ-15, grade Ⅱ-7 and grade Ⅲ-2. The acute toxities were slightly higher in the late course accelerated radiation group than that of the conventional group （45% vs 25%, P =0. 163）. The correlative dosimetric factors included： mean lung dose（MLD）, normal tissue complication probability（NTCP） and volume of lung which received ≥20,25,30,35 Gy. Of the clinicad factors, the volume of gross tumor volume（GTV） was associated with RP（P =0.082）. Only mean lung dose was independently associated with RP according to the multivariate analysis（P =0. 007）, and 3. Acute radiation esophagitis were： grade 0-1 case, grade Ⅰ-24 cases,grade Ⅱ -15 and grade Ⅲ-4 cases. There was no grade Ⅳ. The acute toxities were slightly higher in the late course accelerated radiation group than that of the conventional group, but the difference was insignificant. Conclusions Dosimetric factors （MLD, NT CP, lungs V20, V25, V30, V35） were pronounced predictors of radiation pneumonitis（RP） after 3DCRT for esophageal cancer. According to the multivariate analysis, mean lung dose（MLD） was independently associated with RP. Late course accelerate radiation may increase the aeuse toxicity of esophagus. But there was no significant effect on the incidence of radiation pneumonitis.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2007年第2期103-107,共5页
Chinese Journal of Radiation Oncology
基金
河北省强势特色学科课题
关键词
食管肿瘤
三维适形放射疗法
放射性肺炎
放射性食管炎
Esophageal neoplasms/Three dimensional conformal radiotherapy
Radiation pneumonitis
Radiation esophagitis
