Watkins John M, Wahlquist Amy E, Shirai Keisuke, Garrett-Mayer Elizabeth, Aguero Eric G, Fortney John A, Sherman Carol A, Sharma Anand K
Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Int J Radiat Oncol Biol Phys. 2009 Jul 15;74(4):1108-13. doi: 10.1016/j.ijrobp.2008.09.013. Epub 2008 Dec 10.
To describe incidence and identify factors associated with development of severe acute esophagitis during hyperfractionated radiotherapy with concurrent chemotherapy (BID-CRT) in patients with limited-stage small-cell lung cancer (SCLC).
Retrospective cohort analysis of patient-, tumor-, and treatment-related variables was performed to identify factors associated with Radiation Therapy Oncology Group (RTOG) Grade 3 acute esophagitis. Twice-daily chemoradiotherapy (BID-CRT) involved 45 Gy at 1.5 Gy per fraction, treated twice daily with concurrent platinum-based chemotherapy. Logistic regression analyses were used to identify factors associated with esophagitis.
Between June 1999 and June 2007, 48 patients underwent curative intent BID-CRT for SCLC and were included in the analysis. Median radiotherapy dose was 45 Gy (range, 42-51 Gy) delivered with a median 4 cycles of chemotherapy (range, 2-6). RTOG Grade 3 acute esophagitis developed in 11 patients. No patient developed Grade 4 or 5 esophagitis. Simple logistic regression analyses demonstrated a highly significant association between Grade 3 acute esophagitis and mean esophageal dose (p = 0.002) as well as relative volume dosimetric area under curve (RV-AUC; p = 0.004). Using multiple regression analysis, RV-AUC was identified as the only factor associated with Grade 3 esophagitis (p = 0.004). The most strongly associated dosimetric volume was the V15 (Grade 3 esophagitis rates of 15% vs. 64% for V15 <60% versus >or=60%, respectively).
RV-AUC is the factor most associated with development of Grade 3 acute esophagitis in limited stage SCLC patients receiving BID-CRT.
描述局限期小细胞肺癌（SCLC）患者在超分割放疗同步化疗（每日两次同步放化疗，BID-CRT）期间严重急性食管炎的发生率，并确定与之相关的因素。
对患者、肿瘤和治疗相关变量进行回顾性队列分析，以确定与放射治疗肿瘤学组（RTOG）3级急性食管炎相关的因素。每日两次放化疗（BID-CRT）包括每次1.5 Gy，共45 Gy，每日两次给药并同步铂类化疗。采用逻辑回归分析确定与食管炎相关的因素。
1999年6月至2007年6月期间，48例患者接受了针对SCLC的根治性BID-CRT并纳入分析。中位放疗剂量为45 Gy（范围42 - 51 Gy），中位化疗周期为4个周期（范围2 - 6个周期）。11例患者发生了RTOG 3级急性食管炎。无患者发生4级或5级食管炎。简单逻辑回归分析显示，3级急性食管炎与平均食管剂量（p = 0.002）以及相对体积剂量曲线下面积（RV-AUC；p = 0.004）之间存在高度显著相关性。采用多元回归分析，RV-AUC被确定为与3级食管炎相关的唯一因素（p = 0.004）。相关性最强的剂量体积是V15（V15＜60%和≥60%时3级食管炎发生率分别为15%和64%）。
在接受BID-CRT的局限期SCLC患者中，RV-AUC是与3级急性食管炎发生最相关的因素。
