局部晚期非小细胞肺癌三维适形放疗所致急性放射性食管炎的相关因素分析

摘要

目的 探讨局部晚期非小细胞肺癌(NSCLC)三维适形放疗中急性放射性食管炎(ARE)的相关影响因素.方法 回顾性分析2012年1月至2014年6月期间在我院放疗科接受放疗的NSCLC患者61例,收集全部患者临床资料及三维适形放疗计划物理参数.ARE采用美国肿瘤放射治疗协作组(RTOG)标准,剂量体积直方图(DVH)评估物理参数.组间比较采用χ2检验,变量间的相关性分析采用Spearman相关性检验,多因素分析采用多因素非条件Logistic回归分析.结果 全组ARE发生率为75.4%,其中1级27例,2级17例,3级2例,无4级发生.≥2级ARE发生率为31.1%.同期化疗与≥2级ARE的发生密切相关(χ2=5.636,P=0.018).食管最大剂量、平均剂量、LETT40、LETT45、LETT50、LETT55、LETT60、V40、V45、V50、V55、V60与≥2级ARE的发生具有相关性(r=0.201~0.451,P<0.05).Logistic回归模型显示,同期化疗和食管V55是≥2级ARE的独立影响因素(χ2=4.201、6.566,P=0.040、0.011).结论 同期化疗明显增加了放射性食管炎的发生;食管最大剂量、平均剂量、LETT40~60、V40~60可用来预测急性放射性食管炎的发生,其中V55是最有价值的物理参数.%Objective To analyze the related factors for acute radiation esophagitis (ARE) in patients with lo-cal advanced non-small cell lung cancer (NSCLC) treated by three-dimensional conformal radiotherapy. Methods A retrospective analysis was performed on the clinical and dosimetric parameters of 61 NSCLC patients treated in our hos-pital from January 2012 to June 2014. ARE was evaluated with Radiation Therapy Oncology Group (RTOG) standard, and the dosimetric parameters were estimated by dose volume histogram (DVH). The correlation of the variables were evaluated by Spearman analysis. Comparison among groups was performed byχ2 test, and multi-factor non-conditional logistic regression was used for multivariate analysis. Results In the 61 patients, the incidence of ARE was 75.4%, in-cluding 27 cases at grade 1, 17 cases at grade 2, 2 cases at grade 3, with no case of grade 4. The incidence of ARE of≥grade 2 was 31.1%. Univariate analysis showed concurrent radiochemotherapy was correlated with≥grade 2 ARE (χ2=5.636, P=0.018). Spearman analysis showed the maximum and mean dose of esophagus, the LETT40, LETT45, LETT50, LETT55, LETT60, V40, V45, V50, V55 and V60 of esophagus were correlated with≥grade 2 ARE (r=0.201~0.451, P<0.05). Logistic regression model showed that concurrent radiochemotherapy and V55 of esophagus were the independent factors of ≥2 grade ARE (χ2=4.201, 6.566, P=0.040, 0.011). Conclusion Concurrent radiochemotherapy increases the inci-dence of ARE significantly. The maximum and mean dose of esophagus, LETT40~60, V40~60 of esophagus could be used to predict≥2 grade ARE, in which V55 is of greater importance.