Zhu Shu-Chai, Shen Wen-Bin, Liu Zhi-Kun, Li Juan, Su Jing-Wei, Wang Yu-Xiang
Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang,China.
Tumori. 2011 Sep-Oct;97(5):596-602. doi: 10.1177/030089161109700510.
Radiation-induced lung toxicity occurs frequently in patients with esophageal carcinoma. This study aims to evaluate the clinical and three-dimensional dosimetric parameters associated with lung toxicity after radiotherapy for esophageal carcinoma.
The records of 56 patients treated for esophageal carcinoma were reviewed. The Radiation Therapy Oncology Group criteria for grading of lung toxicity were followed. Spearman's correlation test, the chi-square test and logistic regression analyses were used for statistical analysis.
Ten of the 56 patients developed acute toxicity. The toxicity grades were grade 2 in 7 patients and grade 3 in 3 patients; none of the patients developed grade 4 or worse toxicity. One case of toxicity occurred during radiotherapy and 9 occurred 2 weeks to 3 months after radiotherapy. The median time was 2.0 months after radiotherapy. Fourteen patients developed late irradiated lung injury, 3 after 3.5 months, 7 after 9 months, and 4 after 14 months. Radiographic imaging demonstrated patchy consolidation (n = 5), atelectasis with parenchymal distortion (n = 6), and solid consolidation (n = 3). For acute toxicity, the irradiated esophageal volume, number of fields, and most dosimetric parameters were predictive. For late toxicity, chemotherapy combined with radiotherapy and other dosimetric parameters were predictive. No obvious association between the occurrence of acute and late injury was observed.
The percent of lung tissue receiving at least 25 Gy (V25), the number of fields, and the irradiated length of the esophagus can be used as predictors of the risk of acute toxicity. Lungs V30, as well as chemotherapy combined with radiotherapy, are predictive of late lung injury.
放射性肺毒性在食管癌患者中频繁发生。本研究旨在评估食管癌放疗后与肺毒性相关的临床和三维剂量学参数。
回顾了56例接受食管癌治疗患者的记录。遵循放射治疗肿瘤学组的肺毒性分级标准。采用Spearman相关性检验、卡方检验和逻辑回归分析进行统计分析。
56例患者中有10例发生急性毒性反应。毒性分级为2级的有7例，3级的有3例；无患者发生4级或更严重的毒性反应。1例毒性反应发生在放疗期间，9例发生在放疗后2周~3个月。中位时间为放疗后2.0个月。14例患者发生晚期放射性肺损伤，3例在3.5个月后发生，7例在9个月后发生，4例在14个月后发生。影像学表现为斑片状实变（n = 5）、伴有实质扭曲的肺不张（n = 6）和实性实变（n = 3）。对于急性毒性反应，照射的食管体积、照射野数量和大多数剂量学参数具有预测性。对于晚期毒性反应，化疗联合放疗及其他剂量学参数具有预测性。未观察到急性和晚期损伤发生之间存在明显关联。
接受至少25 Gy的肺组织百分比（V25）、照射野数量和食管的照射长度可作为急性毒性风险的预测指标。肺V30以及化疗联合放疗可预测晚期肺损伤。
