Huang Jin, He Tianyu, Yang Ronghui, Ji Tianlong, Li Guang
Department of Radiotherapy, The First Hospital of China Medical University, Shenyang 110001, China,
Department of Hematology, Shengjing Hospital of China Medical University, Shenyang 110000, China.
Onco Targets Ther. 2018 Sep 21;11:6167-6175. doi: 10.2147/OTT.S174561. eCollection 2018.
The purpose of this study was to estimate the relation between acute esophagitis (AE) and clinical, dosimetric, and position factors in patients with locally advanced non-small-cell lung cancer (NSCLC) receiving intensity-modulated (chemo)radiotherapy.
A retrospective cohort analysis was performed to identify factors associated with Common Toxicity Criteria for Adverse Events grade 2 or worse AE (AE2+). A multivariable model was established including patient- and treatment-related variables and esophageal dose-volume histogram parameters. The esophagus was divided according to physiological anatomy, and logistic regression was used to analyze the position parameter for its correlation with AE2+.
The incidence of AE2+ was 27.5%. All models included gender, concurrent chemo-radiotherapy (CCRT), position parameter, and one of the dosimetric variables. The model with mean dose showed the best goodness of fit. Gender (OR=2.47, =0.014), CCRT (OR=3.67, =0.015), mean dose (OR=1.33, <0.001), and maximum radiation position (OR=1.65, =0.016) were significantly related to AE2+.
Gender, concurrent chemotherapy, maximum radiation position, and mean dose were independent risk factors for AE2+. The upper part of the esophagus showed a higher sensitivity to radiation toxicity.
本研究旨在评估接受调强（化疗）放疗的局部晚期非小细胞肺癌（NSCLC）患者中急性食管炎（AE）与临床、剂量学及体位因素之间的关系。
进行一项回顾性队列分析，以确定与不良事件通用毒性标准2级或更严重AE（AE2+）相关的因素。建立了一个多变量模型，包括患者和治疗相关变量以及食管剂量体积直方图参数。根据生理解剖结构对食管进行划分，并使用逻辑回归分析体位参数与AE2+的相关性。
AE2+的发生率为27.5%。所有模型均包括性别、同步放化疗（CCRT）、体位参数以及一个剂量学变量。平均剂量模型显示出最佳的拟合优度。性别（OR=2.47，P=0.014）、CCRT（OR=3.67，P=0.015）、平均剂量（OR=1.33，P<0.001）以及最大放射部位（OR=1.65，P=0.016）与AE2+显著相关。
性别、同步化疗、最大放射部位和平均剂量是AE2+的独立危险因素。食管上段对放射毒性表现出更高的敏感性。
