Ogino Ichiro, Watanabe Shigenobu, Sakamaki Kentaro, Ogino Yuka, Kunisaki Chikara, Kimura Kazuo
Department of Radiation Oncology, Yokohama City University Medical Center, 4-57 Urahune-cho, Minami-ku, Yokohama, Kanagawa-prefecture, Japan.
Department of Biostatistics, Yokohama City University, Yokohama City University, Yokohama, Japan.
Strahlenther Onkol. 2017 Jul;193(7):552-560. doi: 10.1007/s00066-017-1127-8. Epub 2017 Apr 19.
To evaluate the dose-volume parameters of the pericardium and heart in order to reduce the risk of radiation-induced pericardial effusion (PE) and symptomatic PE (SPE) in esophageal cancer patients treated with concurrent chemoradiotherapy.
In 86 of 303 esophageal cancer patients, follow-up CT was obtained at least 24 months after concurrent chemoradiotherapy. Correlations between clinical factors, including risk factors for cardiac disease, dosimetric factors, and the incidence of PE and SPE after radiotherapy were analyzed using Cox proportional hazard regression analysis. Significant dosimetric factors with the highest hazard ratios were investigated using zones separated according to their distance from esophagus.
PE developed in 49 patients. Univariate analysis showed the mean heart dose, heart V-V, mean pericardium dose, and pericardium V-V to all significantly affect the incidence of PE. Additionally, body surface area was correlated with the incidence of PE in multivariate analysis. Grade 3 and 4 SPE developed in 5 patients. The pericardium V and pericardium D significantly affected the incidence of SPE. The pericardium V in patients with SPE ranged from 17.1 to 21.7%. Factors affecting the incidence of SPE were the V of the pericardium zones within 3 cm and 4 cm of the esophagus.
A wide range of radiation doses to the heart and pericardium were related to the incidence of PE. A pericardium V ≤ 17% is important to avoid symptomatic PE in esophageal cancer patients treated with concurrent chemoradiotherapy.
评估心包和心脏的剂量体积参数，以降低同步放化疗的食管癌患者发生放射性心包积液（PE）和症状性心包积液（SPE）的风险。
在303例食管癌患者中的86例中，同步放化疗后至少24个月进行了随访CT检查。使用Cox比例风险回归分析，分析包括心脏病风险因素在内的临床因素、剂量学因素与放疗后PE和SPE发生率之间的相关性。使用根据与食管的距离划分的区域，研究具有最高风险比的显著剂量学因素。
49例患者发生了PE。单因素分析显示，平均心脏剂量、心脏V-V、平均心包剂量和心包V-V均对PE的发生率有显著影响。此外，在多因素分析中，体表面积与PE的发生率相关。5例患者发生了3级和4级SPE。心包V和心包D对SPE的发生率有显著影响。发生SPE的患者心包V范围为17.1%至21.7%。影响SPE发生率的因素是食管3 cm和4 cm范围内心包区域的V。
心脏和心包的广泛辐射剂量与PE的发生率相关。心包V≤17%对于避免同步放化疗的食管癌患者发生症状性PE很重要。
