Nieder Carsten, Imingen Kristian
Oncology, Nordland Hospital Trust, Bodø, NOR.
Cureus. 2021 Jan 5;13(1):e12494. doi: 10.7759/cureus.12494.
Palliative radiotherapy or chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC) may cause thoracic toxicities due to the radiation dose delivered to the lungs, heart, and esophagus. We studied severe thoracic toxicities resulting in hospitalization or death during the acute and sub-acute phase, i.e., three months from commencing radiotherapy. In addition, risk factors were identified. Methods: A retrospective review of 165 patients treated with three-dimensional conformal palliative radiotherapy or CRT was performed. The prescribed total dose was equivalent to at least 30 Gy in 10 fractions. Uni- and multivariate analyses were employed.
Twelve patients (7%) were hospitalized within three months from the start of radiotherapy or CRT. Six patients were hospitalized for esophagitis, three for dyspnea most likely caused by pneumonitis, and three for cardiac arrhythmia. Fatal toxicity was not observed. However, 19% of the 165 patients died from tumor-related causes during the time period of interest. In multivariate analysis, the only esophageal dose was significantly associated with the risk of hospitalization. Conclusion: The safety profile of palliative radiotherapy or CRT in the acute and subacute phases was satisfactory. The hospitalization rate can be reduced by lowering the esophageal dose, as long as safe lung and heart doses can be maintained.
非小细胞肺癌（NSCLC）的姑息性放疗或放化疗（CRT）可能会因肺部、心脏和食管所接受的辐射剂量而导致胸部毒性反应。我们研究了在放疗开始后的急性期和亚急性期（即三个月内）导致住院或死亡的严重胸部毒性反应。此外，还确定了危险因素。方法：对165例接受三维适形姑息性放疗或CRT治疗的患者进行回顾性分析。处方总剂量相当于至少30 Gy，分10次给予。采用单因素和多因素分析。
12例患者（7%）在放疗或CRT开始后的三个月内住院。6例因食管炎住院，3例因可能由肺炎引起的呼吸困难住院，3例因心律失常住院。未观察到致命毒性反应。然而，在感兴趣的时间段内，165例患者中有19%死于肿瘤相关原因。多因素分析显示，仅食管剂量与住院风险显著相关。结论：姑息性放疗或CRT在急性期和亚急性期的安全性良好。只要能维持安全的肺部和心脏剂量，降低食管剂量可降低住院率。
