Takata Noriko, Kataoka Masaaki, Hamamoto Yasushi, Tsuruoka Shintaro, Kanzaki Hiromitsu, Uwatsu Kotaro, Nagasaki Kei, Mochizuki Teruhito
Department of Radiotherapy, Shikoku Cancer Center Hospital, Kou 160, Minami-Umemoto, Matsuyama, Ehime 791-0280, Japan.
Department of Radiology, Ehime University Hospital, Shitsukawa, Tohon, Ehime 791-0295, Japan.
J Radiat Res. 2018 May 1;59(3):291-297. doi: 10.1093/jrr/rry029.
Pericardial effusion is an important late toxicity after concurrent chemoradiotherapy (CCRT) for locally advanced esophageal cancer. We investigated the clinical and dosimetric factors that were related to pericardial effusion among patients with thoracic esophageal cancer who were treated with definitive CCRT using the two opposed fields technique (TFT) or the four-field technique (FFT), as well as the effectiveness of FFT. During 2007-2015, 169 patients with middle and/or lower thoracic esophageal cancer received definitive CCRT, and 94 patients were evaluable (51 FFT cases and 43 TFT cases). Pericardial effusion was observed in 74 patients (79%) and appeared at 1-18.5 months (median: 5.25 months) after CCRT. The 1-year incidences of pericardial effusions were 73.2% and 76.7% in the FFT and TFT groups, respectively (P = 0.6395). The mean doses to the pericardium were 28.6 Gy and 31.8 Gy in the FFT and TFT groups, respectively (P = 0.0259), and the V40 Gy proportions were 33.5% and 48.2% in the FFT and TFT groups, respectively (P < 0.0001). Grade 3 pericardial effusion was not observed in patients with a pericardial V40 Gy of <40%, or in patients who were treated using the FFT. Although the mean pericardial dose and V40 Gy in the FFT group were smaller than those in the TFT group, the incidences of pericardial effusion after CCRT were similar in both groups. As symptomatic pericardial effusion was not observed in patients with a pericardial V40 Gy of <40% or in the FFT group, it appears that FFT with a V40 Gy of <40% could help minimize symptomatic pericardial effusion.
心包积液是局部晚期食管癌同步放化疗（CCRT）后的一种重要晚期毒性反应。我们调查了采用两野对穿技术（TFT）或四野技术（FFT）进行根治性CCRT治疗的胸段食管癌患者中与心包积液相关的临床和剂量学因素，以及FFT的有效性。在2007年至2015年期间，169例中下段胸段食管癌患者接受了根治性CCRT，94例患者可评估（51例FFT病例和43例TFT病例）。74例患者（79%）出现心包积液，且在心包积液出现在CCRT后1至18.5个月（中位时间：5.25个月）。FFT组和TFT组心包积液的1年发生率分别为73.2%和76.7%（P = 0.6395）。FFT组和TFT组心包的平均剂量分别为28.6 Gy和31.8 Gy（P = 0.0259），V40 Gy比例分别为33.5%和48.2%（P < 0.0001）。心包V40 Gy < 40%的患者或采用FFT治疗的患者未观察到3级心包积液。虽然FFT组的心包平均剂量和V40 Gy低于TFT组，但两组CCRT后心包积液的发生率相似。由于心包V40 Gy < 40%的患者或FFT组未观察到有症状的心包积液，因此V40 Gy < 40%的FFT似乎有助于将有症状的心包积液降到最低。
