摘要
目的:比较RTOG急性放射性损伤分级标准及CTCAE 3.0版不良事件通用术语标准对急性放射性心脏损伤(radiation-induced heart disease,RIHD)的诊断和分级标准的符合情况,为筛选适合临床应用的诊断标准提供参考。方法:收集2008-12-10-2012-08-20河北医科大学第四医院放疗科接受适形或调强放疗的胸部肿瘤患者109例,全部具有放疗前、放疗结束及自放疗开始3个月心肌酶、肌钙蛋白Ⅰ(troponinⅠ,cTnⅠ)、超声心动图、心电图及胸部CT检查资料,应用RTOG急性放射性损伤分级标准及CTCAE3.0版不良事件通用术语标准分别对RIHD发生情况和分级标准的符合情况进行评价。结果:按CTCAE 3.0版不良事件通用术语标准进行评价发生急性RIHD 87例,总发生率为79.8%,其中1级73例,2级14例。按RTOG急性放射性损伤分级标准评价发生RIHD 57例,总发生率为52.3%,其中1级48例,2级9例。CTCAE 3.0版不良事件通用术语标准对RIHD的诊断率明显高于RTOG急性放射性损伤分级标准诊断率,P<0.001。RTOG急性放射性损伤分级标准为0级而CTCAE 3.0版不良事件通用术语标准为1级29例,2级1例;RTOG为1级而CTCAE 3.0为2级的6例;RTOG为2级而CTCAE 3.0为1级的2例。2种分级标准中均为0级22例,均为1级42例,均为2级7例,2种标准在评价急性RIHD不同分级标准上差异有统计学意义,McNemarBowker W=32.000,P<0.001。结论:相对于RTOG标准,CTCAE 3.0版不良事件通用术语标准对于急性RIHD具有较高的诊断率。2种诊断标准评价RIHD在不同分级上存在差异,CTCAE 3.0版分级标准较为详细。CTCAE 3.0版分级标准比较适用于早期对RIHD高危人群的诊断和筛查。
OBJECTIVE：To compare RTOG acute radiation morbidity scoring schema and Common Terminology Criteria for Adverse Events,3.0 version（CTCAE 3.0） on acute radiation-induced heart damage （RIHD）,and provide the suitable reference for clinical application. METHODS.. From December 10th, 2008 to August 20th, 2012,109 cases with thoracic neoplasms who received three-dimensional conformal radiotherapy or intensity-modulated radiotherapy were in- volved in the study. All the patients underwent serum myocardial enzyme and troponin I examination,echocardiography, electrocardiogram and chest CT scan before the irradiation at the end of the irradiation and within 3 months since the irra- diation began. The acute RIHD were evaluated by RTOG acute radiation morbidity scoring schema and CTCAE3.0 version simultaneously. RESULTS： According to Common Terminology Criteria for Adverse Events（3.0 version） ,a total of 87 ca- ses were acute RIHD and the incidence rate was 79.8% ,including 73 cases of 1 grade, 14 cases of 2 grade. According to RTOG acute radiation morbidity scoring schema,a total of 57 cases were acute RIHD and the incidence rate was 52.3 %, including 48 cases of 1 grade,9 cases of 2 grade. The diagnosis rate of the acute RIHD by CTCAE3.0 version was much higher than that by RTOG acute radiation morbidity schema （P〈0. 001）. According to RTOG acute radiation morbidity schema, a total of 29 cases were 0 grade but 1 grade by CTCAE3.0 version, 1 case was 0 grade but 2 grade by CTCAE3.0 version,6 cases were 1 grade but 2 grade by CTCAE3.0 version,2 cases were 2 grade but 1 grade by CTCAE3.0 version.Whichever classification criteria was used, there were 22 cases of 0 grade,42 cases of 1 grade and 7 cases of 2 grade. There were significant differences in the evaluation of grade scales on the acute RIHD with the two classification criteria （Mc- Nemar-Bowker W=32. 000,P〈0. 001 ）. CONCLUSIONS： The higher incidence of the acute RIHD is detected by CT- CAE3.0 version than by RTOG acute radiation morbidity scoring schema. There are significant differences in the evalua- tion of grade scales on the RIHD with the two different criteria. CTCAE3.0 version has more detailed information. CT- CAE3.0 version is probably suitable for the early RIHD diagnosis and high-risk population screening.
出处
《中华肿瘤防治杂志》
CAS
北大核心
2014年第6期469-472,共4页
Chinese Journal of Cancer Prevention and Treatment
基金
河北省二〇〇九年医学科学研究重点课题(20090502)
