Hayashi K, Fujiwara Y, Nomura M, Kamata M, Kojima H, Kohzai M, Sumita K, Tanigawa N
1 Department of Radiology, Kansai Medical University, Hirakata, Japan.
Br J Radiol. 2015 Feb;88(1046):20140168. doi: 10.1259/bjr.20140168. Epub 2014 Nov 27.
To identify predictive factors for the development of pericardial effusion (PCE) in patients with oesophageal cancer treated with chemotherapy and radiotherapy (RT).
From March 2006 to November 2012, patients with oesophageal cancer treated with chemoradiotherapy (CRT) using the following criteria were evaluated: radiation dose >50 Gy; heart included in the radiation field; dose-volume histogram (DVH) data available for analysis; no previous thoracic surgery; and no PCE before treatment. The diagnosis of PCE was independently determined by two radiologists. Clinical factors, the percentage of heart volume receiving >5-60 Gy in increments of 5 Gy (V5-60, respectively), maximum heart dose and mean heart dose were analysed.
A total of 143 patients with oesophageal cancer were reviewed retrospectively. The median follow-up by CT was 15 months (range, 2.1-72.6 months) after RT. PCE developed in 55 patients (38.5%) after RT, and the median time to develop PCE was 3.5 months (range, 0.2-9.9 months). On univariate analysis, DVH parameters except for V60 were significantly associated with the development of PCE (p < 0.001). No clinical factor was significantly related to the development of PCE. Recursive partitioning analysis including all DVH parameters as variables showed a V10 cut-off value of 72.8% to be the most influential factor.
The present results showed that DVH parameters are strong independent predictive factors for the development of PCE in patients with oesophageal cancer treated with CRT.
A heart dosage was associated with the development of PCE with radiation and without prophylactic nodal irradiation.
确定接受化疗和放疗（RT）的食管癌患者发生心包积液（PCE）的预测因素。
对2006年3月至2012年11月期间接受放化疗（CRT）的食管癌患者进行评估，纳入标准如下：放射剂量>50 Gy；心脏包括在放射野内；有剂量体积直方图（DVH）数据可供分析；既往无胸外科手术史；治疗前无PCE。PCE的诊断由两名放射科医生独立确定。分析临床因素、接受>5 - 60 Gy（以5 Gy递增）的心脏体积百分比（分别为V5 - 60）、最大心脏剂量和平均心脏剂量。
对143例食管癌患者进行回顾性分析。放疗后CT的中位随访时间为15个月（范围2.1 - 72.6个月）。放疗后55例患者（38.5%）发生PCE，发生PCE的中位时间为3.5个月（范围0.2 - 9.9个月）。单因素分析显示，除V60外，DVH参数与PCE的发生显著相关（p < 0.001）。无临床因素与PCE的发生显著相关。将所有DVH参数作为变量的递归划分分析显示，V10截止值为72.8%是最有影响的因素。
目前结果表明，DVH参数是接受CRT的食管癌患者发生PCE的强有力独立预测因素。
心脏剂量与放疗且无预防性淋巴结照射情况下PCE的发生相关。
