Giuliani Meredith E, Lindsay Patricia E, Kwan Jennifer Y Y, Sun Alexander, Bezjak Andrea, Le Lisa W, Brade Anthony, Cho John, Leighl Natasha B, Shepherd Frances A, Hope Andrew J
Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
Clin Lung Cancer. 2015 May;16(3):216-20. doi: 10.1016/j.cllc.2014.11.008. Epub 2014 Dec 2.
The purpose of the study was to correlate clinical and dosimetric factors with the development of esophagitis and radiation pneumonitis in patients with limited-stage small-cell lung carcinoma (LS SCLC).
One hundred eighteen patients who received curative intent chemoradiotherapy for LS SCLC and had electronically archived radiation treatment plans were included. The medical charts were reviewed for clinical data. The treatment plan was reviewed for critical structure delineation and dose delivered. Treatment planning data were analyzed using Computational Environment for Radiotherapy Research (V3.3). Dosimetric parameters were correlated with the risk of toxicity using Spearman rank correlation.
Radiotherapy dose was 40 Gy in 15 fractions (fx) (n = 80) and 45 Gy in 30 fractions twice per day (n = 38). The 6-month cumulative incidence of Grade ≥ 2 radiation pneumonitis was 6.5% and 7.9% for the 40 Gy/15 fx and 45 Gy/30 fx groups, respectively (P = .40). The 3-month cumulative incidence of Grade 3 esophagitis was 7.5% and 13.2% for the 40 Gy/15 fx and 45 Gy/30 fx groups, respectively (P = .31). Grade ≥ 3 pneumonitis was correlated with volume of lung receiving 20 Gy (V20) and mean lung dose. Grade ≥ 3 esophagitis was correlated with mean esophagus dose and minimum dose to the hottest 45% of the esophagus (D45).
Mean lung dose and V20 were significant predictors of radiation pneumonitis in LS SCLC. Mean esophageal dose and D45 were significant predictors of esophagitis. These 2 treatment schedules have similar toxicity profiles.
本研究旨在探讨局限期小细胞肺癌（LS SCLC）患者食管炎和放射性肺炎的发生与临床及剂量学因素之间的相关性。
纳入118例接受根治性放化疗的LS SCLC患者，这些患者的放射治疗计划已进行电子存档。查阅病历以获取临床数据，审查治疗计划以确定关键结构的勾画和所给予的剂量。使用放射治疗研究计算环境（V3.3）分析治疗计划数据。采用Spearman等级相关性分析剂量学参数与毒性风险之间的相关性。
放疗剂量为40 Gy分15次（n = 80）和45 Gy分30次每天2次（n = 38）。40 Gy/15次组和45 Gy/30次组≥2级放射性肺炎的6个月累积发生率分别为6.5%和7.9%（P = 0.40）。40 Gy/15次组和45 Gy/30次组3级食管炎的3个月累积发生率分别为7.5%和13.2%（P = 0.31）。≥3级肺炎与接受20 Gy照射的肺体积（V20）和平均肺剂量相关。≥3级食管炎与平均食管剂量和食管最热45%区域的最小剂量（D45）相关。
平均肺剂量和V20是LS SCLC患者放射性肺炎的重要预测指标。平均食管剂量和D45是食管炎的重要预测指标。这两种治疗方案的毒性特征相似。
