CAJ | 학술논문

目的观察三维适形放疗(3DCRT)联合长春瑞滨+顺铂(NP)同步化疗Ⅲ期非小细胞肺癌(NSCLC)的急性放射性食管炎发生情况,并对相关因素进行分析,以求得到合理的预测性指标.方法 37例Ⅲ期NSCLC患者接受3DCRT及NP方案同步化疗,放疗处方剂量60 Cy,1.8～2.0Cy/次,5次/周,共30～34次,于放疗开始的第1、5周给予同步化疗,观察急性放射性食管炎发生情况并进行相关因素及受试者工作特征(ROC)曲线分析.结果全组食管炎总发生率为92%(34例),其中0级3例,1级11例,2级9例,3级14例,无4级发生.单因素分析显示食管接受的平均剂量、LETT_(40)、LETT_(45)、LETT_(50)、LETT_(55)、LETT_(60)、V_(40)、V_(45)、V_(50)、V_(55)、V_(60)均与放射性食管炎具有较好相关性,能预测急性放射性食管炎发生;多因素分析结果提示食管V_55是预测放射性食管炎的最有价值的指标.ROC曲线分析结果示曲线下面积为0.906(P=0.000),曲线界值V_(55)=30%;食管V_(55)>30%组与≤30%组≥2级放射性食管炎发生率分别为100%(15/15)和36%(8/22).结论对局部晚期NSCLC进行3DCRT结合同步化疗可出现较严重放射性食管炎,食管接受的平均剂量、LETT_(40)、LETT_(45)、LETT_(50)、LETT_(55)、LETT_(60)、V_(40)、V_(45)、V_(50)、V_(55)、V_(60)可较好预测放射性食管炎的发生,V_(55)可能是最有价值的预测性指标,当V_55>30%时2、3级急性放射性食管炎的发生率可能会明显增加.
목적 관찰삼유괄형방료(3DCRT)연합장춘서빈+순박(NP)동보화료Ⅲ기비소세포폐암(NSCLC)적급성방사성식관염발생정황,병대상관인소진행분석,이구득도합리적예측성지표.방법 37례Ⅲ기NSCLC환자접수3DCRT급NP방안동보화료,방료처방제량60 Cy,1.8～2.0Cy/차,5차/주,공30～34차,우방료개시적제1、5주급여동보화료,관찰급성방사성식관염발생정황병진행상관인소급수시자공작특정(ROC)곡선분석.결과 전조식관염총발생솔위92%(34례),기중0급3례,1급11례,2급9례,3급14례,무4급발생.단인소분석현시식관접수적평균제량、LETT_(40)、LETT_(45)、LETT_(50)、LETT_(55)、LETT_(60)、V_(40)、V_(45)、V_(50)、V_(55)、V_(60)균여방사성식관염구유교호상관성,능예측급성방사성식관염발생;다인소분석결과제시식관V_55시예측방사성식관염적최유개치적지표.ROC곡선분석결과시곡선하면적위0.906(P=0.000),곡선계치V_(55)=30%;식관V_(55)>30%조여≤30%조≥2급방사성식관염발생솔분별위100%(15/15)화36%(8/22).결론 대국부만기NSCLC진행3DCRT결합동보화료가출현교엄중방사성식관염,식관접수적평균제량、LETT_(40)、LETT_(45)、LETT_(50)、LETT_(55)、LETT_(60)、V_(40)、V_(45)、V_(50)、V_(55)、V_(60)가교호예측방사성식관염적발생,V_(55)가능시최유개치적예측성지표,당V_55>30%시2、3급급성방사성식관염적발생솔가능회명현증가.
Objective To investigate the radiation-induced esophageal toxicities in Ⅲ stage non-small cell lung cancer (NSCLC) treated by three-dimensional conformal radiotherapy (3DCRT) combined with concurrent chemotherapy, and to find the relevant predictive factors. Methods From September 2006 to October 2007, 37 patients with stage Ⅲ NSCLC were treated by 3 DCRT (60 Gy in 30-34 fractions) con-currently with navelbine and cisplatin (NP). Chemotherapy was given in the first and fifth week. Univariate and multivariate analyses and receiver operating characteristic curves (ROC) were used to assess the associ-ation of radiation-induced esophagitis and correlated factors. Results Of all the patients, 91.89% (34/37) developed radiation-induced esophagitis, including grade 1 in 11 patients, grade 2 in 9, grade 3 in 14 and grade 4 in none. According to Spearman correlative analysis, the correlative factors included mean esophagus dose (MED), the LETT_(40)、LETT_(45)、LETT_(50)、LETT_(55)、LETT_60)of esophagus.All the 11 factors had good correlation with esophagitis in univariate analysis, while only V_55 was independ-ently associated with esophagitis in multivariate analysis. The ROC analysis indicated that the cut-off point of the curve was 30% with the area under ROC curve of 0.906, (P=0.000). Grade 2 or 3 radiation esophagi-tis occurred in all the patients with esophageal V_55 > 30%, while only in 36% ( 8/22 ) of those with V_55<30%. Conclusions 3DCRT combined with concurrent chemotherapy in patients with stage Ⅲ NSCLC could develop severe esophagitis. Dosimetric parameters (MED, LETT_(40),LETT_(45),LETT_(50),LETT_(55),LETT_(60),V_(40),V_(45),V_50,V_55,V_(60))are related with esophagitis,V_55 with V_55 > 30% being the most valuable predictor.