Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jiyan Road 440, Jinan, China.
Am J Clin Oncol. 2010 Jun;33(3):271-5. doi: 10.1097/COC.0b013e3181a879e0.
To analyze the clinical and dosimetric risk factors of acute esophagitis (AE) in non-small-cell lung cancer (NSCLC) patients treated with 3-dimensional conformal radiotherapy (3D-CRT).
One hundred two NSCLC patients treated with 3D-CRT were retrospectively analyzed. Forty of these 102 patients analyzed were treated with concurrent chemotherapy (CCT). The median biologic effective dose of radiotherapy was 72.0 Gy. AE was scored according to the Radiation Therapy Oncology Group criteria. The clinical and dosimetric factors associated with grade 2 or worse AE were analyzed using univariate and multivariate binary logistic analysis.
There were no grade 4 or 5 AE observed in the 102 patients analyzed. Thirty-four of 102 patients (33.3%) developed grade 2 or 3 AE. Univariate analysis showed that clinical factors, such as lymph nodes stage (N 0/1 vs. N 2/3), pretreatment weight loss > or =5%, CCT, and the use of late-course hyperfractionated radiotherapy were significantly associated with grade 2 and 3 AE. Dose volume parameters of esophagus including mean esophageal dose, maximal esophageal dose, rV15, rV20, rV25, rV30, rV35, rV40, rV45, rV50, rV55, rV60 were also associated with AE. On multivariate forward step-wise logistic analysis, CCT, lymph nodes stage, and rV55 emerged as the statistically most significant factors of AE with OR parameters of 8.911, 4.832, and 1.083, respectively.
CCT, lymphatic status, and rV55 were strong predictors of grade 2 or worse AE in NSCLC treated with 3D-CRT.
分析三维适形放疗（3D-CRT）治疗非小细胞肺癌（NSCLC）患者急性食管炎（AE）的临床和剂量学危险因素。
回顾性分析 102 例接受 3D-CRT 治疗的 NSCLC 患者。对其中 40 例进行了同期化疗（CCT）分析。放疗的中位生物有效剂量为 72.0Gy。根据放射治疗肿瘤学组（RTOG）标准对 AE 进行评分。采用单因素和多因素二项逻辑分析，分析与 2 级或更高级别 AE 相关的临床和剂量学因素。
在 102 例患者中未观察到 4 级或 5 级 AE。102 例患者中有 34 例（33.3%）发生 2 级或 3 级 AE。单因素分析显示，临床因素如淋巴结分期（N0/1 与 N2/3）、治疗前体重减轻>5%、CCT、以及使用后期超分割放疗与 2 级和 3 级 AE 显著相关。食管的剂量学参数包括平均食管剂量、最大食管剂量、rV15、rV20、rV25、rV30、rV35、rV40、rV45、rV50、rV55、rV60，也与 AE 相关。多因素向前逐步逻辑分析显示，CCT、淋巴结分期和 rV55 是 AE 的统计学上最重要的因素，OR 参数分别为 8.911、4.832 和 1.083。
CCT、淋巴状态和 rV55 是 3D-CRT 治疗 NSCLC 患者 2 级或更高级别 AE 的强烈预测因素。
