肺癌患者放疗后急性食管炎的剂量学相关性
Dosimetric correlations of acute esophagitis in lung cancer patients treated with radiotherapy.
作者信息
Takeda Ken, Nemoto Kenji, Saito Haruo, Ogawa Yoshihiro, Takai Yoshihiro, Yamada Shogo
机构信息
Department of Radiology, National Hospital Organization Sendai Medical Center, Sendai, Japan.
出版信息
Int J Radiat Oncol Biol Phys. 2005 Jul 1;62(3):626-9. doi: 10.1016/j.ijrobp.2005.04.004.
PURPOSE
To evaluate the factors associated with acute esophagitis in lung cancer patients treated with thoracic radiotherapy.
METHODS AND MATERIALS
We examined 35 patients with non-small-cell lung cancer (n = 27, 77%) and small-cell lung cancer (n = 8, 23%) treated with thoracic radiotherapy between February 2003 and November 2004. The median patient age was 70 years (range, 50-83 years). The disease stage was Stage I in 2 patients (6%), Stage II in 1 (3%), Stage IIIa in 10 (28%), Stage IIIb in 9 (26%), and Stage IV in 9 (26%); 4 patients (11%) had recurrent disease after surgery. A median dose of 60 Gy (range, 50-67 Gy) was given to the isocenter and delivered in single daily fractions of 1.8 or 2 Gy. With heterogeneity corrections, the median given dose to the isocenter was 60.3 Gy (range, 49.9-67.2 Gy). Of the 35 patients, 30 (86%) received concurrent chemotherapy consisting of a platinum agent, cisplatin or carboplatin, combined with paclitaxel in 18 patients (52%), irinotecan hydrochloride in 7 (20%), vincristine sulfate and etoposide in 2 (5%), vinorelbine ditartrate in 1 (3%), etoposide in 1 (3%), and docetaxel in 1 patient (3%). Three of these patients underwent induction therapy with cisplatin and irinotecan hydrochloride, administered before thoracic radiotherapy, and concurrent chemotherapy. Esophageal toxicity was graded according to the Radiation Therapy Oncology Group criteria. The following factors were analyzed with respect to their association with Grade 1 or worse esophagitis by univariate and multivariate analyses: age, gender, concurrent chemotherapy, chemotherapeutic agents, maximal esophageal dose, mean esophageal dose, and percentage of esophageal volume receiving >10 to >65 Gy in 5-Gy increments.
RESULTS
Of the 35 patients, 25 (71%) developed acute esophagitis, with Grade 1 in 20 (57%) and Grade 2 in 5 (14%). None of the patients had Grade 3 or worse toxicity. The most significant correlation was between esophagitis and percentage of esophageal volume receiving >35 Gy on univariate (p = 0.002) and multivariate (p = 0.018) analyses.
CONCLUSION
The percentage of esophageal volume receiving >35 Gy was the most statistically significant factor associated with mild acute esophagitis.
目的
评估接受胸部放疗的肺癌患者发生急性食管炎的相关因素。
方法与材料
我们研究了2003年2月至2004年11月期间接受胸部放疗的35例非小细胞肺癌患者（n = 27，77%）和小细胞肺癌患者（n = 8，23%）。患者中位年龄为70岁（范围50 - 83岁）。疾病分期为Ⅰ期2例（6%），Ⅱ期1例（3%），Ⅲa期10例（28%），Ⅲb期9例（26%），Ⅳ期9例（26%）；4例（11%）患者术后复发。等中心中位剂量为60 Gy（范围50 - 67 Gy），每日单次剂量为1.8或2 Gy。经异质性校正后，等中心中位给予剂量为60.3 Gy（范围49.9 - 67.2 Gy）。35例患者中，30例（86%）接受了同步化疗，其中18例（52%）为铂类药物顺铂或卡铂联合紫杉醇，7例（20%）联合盐酸伊立替康，2例（5%）联合硫酸长春新碱和依托泊苷，1例（3%）联合多西他赛，1例（3%）联合长春瑞滨，1例（3%）联合依托泊苷。其中3例患者在胸部放疗前接受了顺铂和盐酸伊立替康的诱导治疗以及同步化疗。食管毒性根据放射治疗肿瘤学组标准进行分级。通过单因素和多因素分析，对以下因素与1级或更严重食管炎的相关性进行了分析：年龄、性别、同步化疗、化疗药物、食管最大剂量、食管平均剂量以及食管接受＞10至＞65 Gy（以5 Gy递增）的体积百分比。
结果
35例患者中，25例（71%）发生急性食管炎，其中1级20例（57%），2级5例（14%）。无患者出现3级或更严重毒性。在单因素分析（p = 0.002）和多因素分析（p = 0.018）中，食管炎与食管接受＞35 Gy体积百分比之间的相关性最为显著。
结论
食管接受＞35 Gy的体积百分比是与轻度急性食管炎相关的最具统计学意义的因素。
Zotero 插件