Patel Ashish B, Edelman Martin J, Kwok Young, Krasna Mark J, Suntharalingam Mohan
Department of Radiation Oncology, University of Maryland Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA.
Int J Radiat Oncol Biol Phys. 2004 Nov 15;60(4):1106-12. doi: 10.1016/j.ijrobp.2004.04.051.
To evaluate possible clinical and dosimetric predictors of acute esophagitis in patients with locally advanced non-small-cell lung carcinoma treated in a prospective Phase I-II trimodality protocol.
The data from 36 patients with Stage III non-small-cell lung carcinoma treated in a Phase I-II high-dose concurrent chemoradiotherapy protocol were analyzed for possible predictors of acute esophagitis. The median age was 58 years (range, 38-77 years). Patients included in this study had either Stage IIIA (n = 24) or IIIB (n = 12) disease. All patients were treated with induction concurrent carboplatin (area under the plasma concentration-time curve 1), vinorelbine (5-15 mg/m(2)), and hyperfractionated radiotherapy (69.6 Gy) followed by consolidation chemotherapy (carboplatin area under the plasma concentration-time curve 6, vinorelbine 25 mg/m(2), docetaxel 75 mg/m(2)) or surgery (n = 19) plus consolidation chemotherapy. Acute toxicities were graded using the Radiation Therapy Oncology Group criteria. The following clinical and dosimetric parameters were analyzed: age, gender, race, T stage, N stage, pretreatment body mass index, percentage of weight lost during therapy, pretherapy serum albumin, tumor location, length of esophagus in treatment field, percentage of esophagus volume treated to >40, >45, >50, >55, >60, and >65 Gy. These parameters were coded and analyzed against Grade 2 and worse esophagitis using univariate and multivariate regression analyses.
Of the 36 patients, Grade 1, 2, and 3 acute esophagitis was observed in 16 (44%), 12 (33%), and 2 (5.5%) patients, respectively. Grade 4 or 5 toxicity was not observed in this patient cohort. Only the pretreatment body mass index (rho = -0.431, p = 0.004) and percentage of esophagus volume treated to >50 Gy (rho = 0.297, p = 0.040) demonstrated a statistically significant correlation with the incidence of Grade 2 or worse esophagitis on univariate analysis. These parameters retained their statistical significance on multivariate regression analysis (p = 0.029 and 0.049, respectively).
In patients undergoing concurrent high-dose chemotherapy and hyperfractionated radiotherapy, a low pretherapy body mass index and percentage of esophagus volume treated to >50 Gy were significantly associated with acute Grade 2 or worse esophagitis.
在一项前瞻性I-II期三联疗法方案治疗的局部晚期非小细胞肺癌患者中，评估急性食管炎可能的临床和剂量学预测因素。
分析了36例接受I-II期高剂量同步放化疗方案治疗的III期非小细胞肺癌患者的数据，以寻找急性食管炎可能的预测因素。中位年龄为58岁（范围38 - 77岁）。本研究纳入的患者为IIIA期（n = 24）或IIIB期（n = 12）疾病。所有患者均接受诱导同步卡铂（血浆浓度-时间曲线下面积1）、长春瑞滨（5 - 15 mg/m²）和超分割放疗（69.6 Gy），随后进行巩固化疗（卡铂血浆浓度-时间曲线下面积6、长春瑞滨25 mg/m²、多西他赛75 mg/m²）或手术（n = 19）加巩固化疗。使用放射肿瘤学组标准对急性毒性进行分级。分析了以下临床和剂量学参数：年龄、性别、种族、T分期、N分期、治疗前体重指数、治疗期间体重减轻百分比、治疗前血清白蛋白、肿瘤位置、治疗野内食管长度、接受>40、>45、>50、>55、>60和>65 Gy照射的食管体积百分比。使用单因素和多因素回归分析对这些参数进行编码，并针对2级及以上食管炎进行分析。
36例患者中，分别有16例（44%）、12例（33%）和2例（5.5%）发生1级、2级和3级急性食管炎。该患者队列中未观察到4级或5级毒性。单因素分析中，仅治疗前体重指数（rho = -0.431，p = 0.004）和接受>50 Gy照射的食管体积百分比（rho = 0.297，p = 0.040）与2级及以上食管炎的发生率具有统计学显著相关性。这些参数在多因素回归分析中仍具有统计学显著性（分别为p = 0.029和0.049）。
在接受同步高剂量化疗和超分割放疗的患者中，治疗前低体重指数和接受>50 Gy照射的食管体积百分比与2级及以上急性食管炎显著相关。
