Xu Cai, Guo Lanwei, Liao Zhongxing, Wang Yifan, Liu Xiyou, Zhao Shuangtao, Wang Jun, Yuan Zhiyong, Wang Ping, Lin Steven H
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
Clin Transl Radiat Oncol. 2019 Apr 24;17:17-23. doi: 10.1016/j.ctro.2019.04.016. eCollection 2019 Jul.
To analyze associations between heart and lung dose and overall survival (OS) in patients with esophageal cancer who received concurrent chemo-radiotherapy (CCRT) with or without surgery.
Patients received intensity-modulated radiation therapy (median dose 50.4 Gy) from 2004 through 2016. Cutoff points for continuous variables were calculated using the method of Contal and O'Quigley. Kaplan-Meier method with log-rank tests was used to calculate survival. OS was analyzed with both univariate and multivariable Cox models.
In all, 560 patients were analyzed; median follow-up time was 29.3 months, and 5-year OS rate was 41.7%. Heart V30 >45% and mean lung dose (MLD) >10 Gy were found to be independently associated with worse survival after adjustment for other clinical and dosimetric factors ( < 0.05). Heart and lung doses were also found to be risk factors for radiation-induced cardiac and pulmonary complications ( < 0.05): 8.5% of patients with heart V30 ≤45% had cardiac complications vs. 15% for V30 >45% ( = 0.046); 18.8% of patients with MLD ≤10 Gy had pulmonary complications vs. 27% for MLD >10 Gy ( = 0.020). Having cardiac complications was associated with worse survival (5-year OS rates 27.6% with vs. 43.2% without, = 0.012), and having pulmonary complications was associated with worse survival as well (5-year OS rates 23.1% with vs. 47.4% without, < 0.001).
Both heart and lung doses independently predicted worse OS in patients with esophageal cancer, even after adjustment for other clinical and dosimetric factors, and were also risk factors for radiation-induced complications. Both irradiated heart and lung doses should be minimized as a whole.
分析接受同步放化疗（CCRT）且有或无手术治疗的食管癌患者中心脏和肺部剂量与总生存期（OS）之间的关联。
患者于2004年至2016年接受调强放射治疗（中位剂量50.4 Gy）。连续变量的截断点采用Contal和O'Quigley方法计算。采用Kaplan-Meier法和对数秩检验计算生存率。采用单变量和多变量Cox模型分析总生存期。
共分析560例患者；中位随访时间为29.3个月，5年总生存率为41.7%。在校正其他临床和剂量学因素后，发现心脏V30>45%和平均肺剂量（MLD）>10 Gy与较差的生存率独立相关（P<0.05）。心脏和肺部剂量也是放射性心脏和肺部并发症的危险因素（P<0.05）：心脏V30≤45%的患者中有8.5%发生心脏并发症，而V30>45%的患者中这一比例为15%（P=0.046）；MLD≤10 Gy的患者中有18.8%发生肺部并发症，而MLD>10 Gy的患者中这一比例为27%（P=0.020）。发生心脏并发症与较差的生存率相关（有心脏并发症者5年总生存率为27.6%，无心脏并发症者为43.2%，P=0.012），发生肺部并发症也与较差的生存率相关（有肺部并发症者5年总生存率为23.1%，无肺部并发症者为47.4%，P<0.001）。
即使在校正其他临床和剂量学因素后，心脏和肺部剂量均独立预测食管癌患者较差的总生存期，并且也是放射性并发症的危险因素。应总体上尽量降低心脏和肺部的照射剂量。
