Department of Radiation Oncology, Gunma Prefectural Cancer Center, Ota, Gunma, Japan.
Int J Radiat Oncol Biol Phys. 2011 Jul 15;80(4):1002-7. doi: 10.1016/j.ijrobp.2010.03.046. Epub 2010 Jun 11.
To investigate the dose-volume histogram parameters and clinical factors as predictors of pleural effusion in esophageal cancer patients treated with concurrent chemoradiotherapy (CRT).
Forty-three esophageal cancer patients treated with definitive CRT from January 2001 to March 2007 were reviewed retrospectively on the basis of the following criteria: pathologically confirmed esophageal cancer, available computed tomography scan for treatment planning, 6-month follow-up after CRT, and radiation dose ≥ 50 Gy. Exclusion criteria were lung metastasis, malignant pleural effusion, and surgery. Mean heart dose, mean total lung dose, and percentages of heart or total lung volume receiving ≥ 10-60 Gy (Heart-V(10) to V(60) and Lung-V(10) to V(60), respectively) were analyzed in relation to pleural effusion.
The median follow-up time was 26.9 months (range, 6.7-70.2) after CRT. Of the 43 patients, 15 (35%) developed pleural effusion. By univariate analysis, mean heart dose, Heart-V(10) to V(60), and Lung-V(50) to V(60) were significantly associated with pleural effusion. Poor performance status, primary tumor of the distal esophagus, and age ≥ 65 years were significantly related with pleural effusion. Multivariate analysis identified Heart-V(50) as the strongest predictive factor for pleural effusion (p = 0.01). Patients with Heart-V(50) <20%, 20%≤ Heart-V(50) <40%, and Heart-V(50) ≥ 40% had 6%, 44%, and 64% of pleural effusion, respectively (p < 0.01).
Heart-V(50) is a useful parameter for assessing the risk of pleural effusion and should be reduced to avoid pleural effusion.
研究食管癌患者接受同期放化疗（CRT）后胸腔积液的剂量-体积直方图参数和临床因素预测因素。
回顾性分析了 2001 年 1 月至 2007 年 3 月期间接受根治性 CRT 的 43 例食管癌患者。纳入标准为：经病理证实的食管癌、有治疗计划的 CT 扫描、CRT 后 6 个月随访、放疗剂量≥50Gy。排除标准为肺转移、恶性胸腔积液和手术。分析了平均心脏剂量、全肺平均剂量以及心脏或全肺接受≥10-60Gy 的百分比（分别为 Heart-V(10) 至 V(60) 和 Lung-V(10) 至 V(60)）与胸腔积液的关系。
CRT 后中位随访时间为 26.9 个月（范围为 6.7-70.2）。43 例患者中，15 例（35%）发生胸腔积液。单因素分析显示，平均心脏剂量、Heart-V(10) 至 V(60)和 Lung-V(50) 至 V(60)与胸腔积液显著相关。较差的表现状态、下段食管癌原发灶和年龄≥65 岁与胸腔积液显著相关。多因素分析确定 Heart-V(50)是胸腔积液的最强预测因子（p=0.01）。Heart-V(50)<20%、20%≤Heart-V(50)<40%和 Heart-V(50)≥40%的患者胸腔积液发生率分别为 6%、44%和 64%（p<0.01）。
Heart-V(50)是评估胸腔积液风险的有用参数，应降低以避免胸腔积液。
