高剂量单次脊柱旁立体定向放射外科治疗的食管毒性。
Esophageal toxicity from high-dose, single-fraction paraspinal stereotactic radiosurgery.
机构信息
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
出版信息
Int J Radiat Oncol Biol Phys. 2012 Aug 1;83(5):e661-7. doi: 10.1016/j.ijrobp.2012.01.080. Epub 2012 May 7.
PURPOSE
To report the esophageal toxicity from single-fraction paraspinal stereotactic radiosurgery (SRS) and identify dosimetric and clinical risk factors for toxicity.
METHODS AND MATERIALS
A total of 204 spinal metastases abutting the esophagus (182 patients) were treated with high-dose single-fraction SRS during 2003-2010. Toxicity was scored using the National Cancer Institute Common Toxicity Criteria for Adverse Events, version 4.0. Dose-volume histograms were combined to generate a comprehensive atlas of complication incidence that identifies risk factors for toxicity. Correlation of dose-volume factors with esophageal toxicity was assessed using Fisher's exact test and logistic regression. Clinical factors were correlated with toxicity.
RESULTS
The median dose to the planning treatment volume was 24 Gy. Median follow-up was 12 months (range, 3-81). There were 31 (15%) acute and 24 (12%) late esophageal toxicities. The rate of grade ≥3 acute or late toxicity was 6.8% (14 patients). Fisher's exact test resulted in significant median splits for grade ≥3 toxicity at V12 = 3.78 cm(3) (relative risk [RR] 3.7, P=.05), V15 = 1.87 cm(3) (RR 13, P=.0013), V20 = 0.11 cm(3) (RR 6, P=0.01), and V22 = 0.0 cm(3) (RR 13, P=.0013). The median split for D2.5 cm(3) (14.02 Gy) was also a significant predictor of toxicity (RR 6; P=.01). A highly significant logistic regression model was generated on the basis of D2.5 cm(3). One hundred percent (n = 7) of grade ≥4 toxicities were associated with radiation recall reactions after doxorubicin or gemcitabine chemotherapy or iatrogenic manipulation of the irradiated esophagus.
CONCLUSIONS
High-dose, single-fraction paraspinal SRS has a low rate of grade ≥3 esophageal toxicity. Severe esophageal toxicity is minimized with careful attention to esophageal doses during treatment planning. Iatrogenic manipulation of the irradiated esophagus and systemic agents classically associated with radiation recall reactions are associated with development of grade ≥4 toxicity.
目的
报告单次脊柱旁立体定向放射外科（SRS）引起的食管毒性，并确定与毒性相关的剂量学和临床危险因素。
方法和材料
2003 年至 2010 年间，共有 204 例毗邻食管的脊柱转移瘤（182 例患者）接受了高剂量单次 SRS 治疗。采用美国国立癌症研究所不良事件通用毒性标准（版本 4.0）对毒性进行评分。结合剂量-体积直方图，生成并发症发生率综合图谱，确定毒性的危险因素。采用 Fisher 精确检验和逻辑回归评估剂量-体积因素与食管毒性的相关性。分析临床因素与毒性的相关性。
结果
计划治疗体积的中位剂量为 24 Gy。中位随访时间为 12 个月（范围 3-81 个月）。急性毒性 31 例（15%），迟发性毒性 24 例（12%）。≥3 级急性或迟发性毒性的发生率为 6.8%（14 例）。Fisher 精确检验结果显示，V12 = 3.78 cm³（相对风险 [RR] 3.7，P=.05）、V15 = 1.87 cm³（RR 13，P=.0013）、V20 = 0.11 cm³（RR 6，P=0.01）和 V22 = 0.0 cm³（RR 13，P=.0013）时，≥3 级毒性的中位分割具有显著统计学意义。D2.5 cm³（14.02 Gy）的中位分割也是毒性的显著预测因子（RR 6；P=.01）。基于 D2.5 cm³，建立了一个具有显著意义的逻辑回归模型。100%（n = 7）的≥4 级毒性与阿霉素或吉西他滨化疗或放射治疗食管的医源性操作后出现的放射回忆反应有关。
结论
高剂量单次脊柱旁 SRS 食管毒性发生率较低。在治疗计划中，仔细关注食管剂量可最大程度减少严重的食管毒性。放射治疗后食管的医源性操作和经典地与放射回忆反应相关的全身药物与≥4 级毒性的发生有关。
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