中华放射医学与防护杂志
中華放射醫學與防護雜誌
중화방사의학여방호잡지
Chinese Journal of Radiological Medicine and Protection
2010年
2期
185-188
,共4页
吕冬婕%王澜%韩春%高超%李晓宁
呂鼕婕%王瀾%韓春%高超%李曉寧
려동첩%왕란%한춘%고초%리효저
肺肿瘤%放射疗法%适形放疗%化学疗法%放射性食管损伤
肺腫瘤%放射療法%適形放療%化學療法%放射性食管損傷
폐종류%방사요법%괄형방료%화학요법%방사성식관손상
Lung neoplasm%Conformal radiotherapy%Chemotherapy%Acute radiation esophagitis
目的 观察三维适形放疗联合NP方案同期化疗治疗Ⅲ期非小细胞肺癌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 52例Ⅲ期非小细胞肺癌患者接受三维适形放疗及NP方案同期化疗,放疗处方剂量60 Gy,1.8-2 Gy/次,5次/周,共30～34次,于放疗开始的第1周、第5周给予同期化疗,观察急性放射性食管炎发生情况并进行单因素、多因素及ROC曲线分析.结果 食管炎总发生率为84.6%(44/52),其中0级8例(15.3%).1级16例(30.8%),2级12例(23.1%),3级16例(30.8%),无4级发生.相关因素分析及Binary Logistic单因素分析显示.食管接受的平均剂量(MED)、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的相关性,能预测急性放射性食管炎的发生(X~2=7.355～8.690,P<0.05);多因素分析结果提示,食管V_(55),是预测放射性食管炎最有价值的指标.ROC曲线(受试者工作特征曲线)分析结果显示,曲线下面积为0.725(P=0.006),曲线界值为V_(55)=26%,食管V_(55),>26%组与≤26%组2级及以上放射性食管炎的发生率分别为67.7%(21/31)和33.3%(7/21).结论 对局部晚期NSCLC进行三维适形放疗及同期化疗,可出现较严重的放射性食管炎,食管MED、LETT_(40)、LETT_(45)、LETT_(50)、LETT_(55)、LETT_(60)、V_(40)、V_(45)、V_(50)、V_(55)、V_(60)可以较好地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)>26%时,2、3级急性放射性食管炎的发生率可能会明显增加.
目的 觀察三維適形放療聯閤NP方案同期化療治療Ⅲ期非小細胞肺癌的急性放射性食管炎髮生情況,併對相關因素進行分析,以求得到閤理的預測性指標.方法 52例Ⅲ期非小細胞肺癌患者接受三維適形放療及NP方案同期化療,放療處方劑量60 Gy,1.8-2 Gy/次,5次/週,共30～34次,于放療開始的第1週、第5週給予同期化療,觀察急性放射性食管炎髮生情況併進行單因素、多因素及ROC麯線分析.結果 食管炎總髮生率為84.6%(44/52),其中0級8例(15.3%).1級16例(30.8%),2級12例(23.1%),3級16例(30.8%),無4級髮生.相關因素分析及Binary Logistic單因素分析顯示.食管接受的平均劑量(MED)、LETT_(40)、LETT_(45)、LETT_(50)、LETT_(55)、LETT_(60)、V_(40)、V_(45)、V_(50)、V_(55)、V_(60)均與放射性食管炎具有較好的相關性,能預測急性放射性食管炎的髮生(X~2=7.355～8.690,P<0.05);多因素分析結果提示,食管V_(55),是預測放射性食管炎最有價值的指標.ROC麯線(受試者工作特徵麯線)分析結果顯示,麯線下麵積為0.725(P=0.006),麯線界值為V_(55)=26%,食管V_(55),>26%組與≤26%組2級及以上放射性食管炎的髮生率分彆為67.7%(21/31)和33.3%(7/21).結論 對跼部晚期NSCLC進行三維適形放療及同期化療,可齣現較嚴重的放射性食管炎,食管MED、LETT_(40)、LETT_(45)、LETT_(50)、LETT_(55)、LETT_(60)、V_(40)、V_(45)、V_(50)、V_(55)、V_(60)可以較好地預測放射性食管炎的髮生,V_(55)可能是最有價值的預測性指標.噹V_(55)>26%時,2、3級急性放射性食管炎的髮生率可能會明顯增加.
목적 관찰삼유괄형방료연합NP방안동기화료치료Ⅲ기비소세포폐암적급성방사성식관염발생정황,병대상관인소진행분석,이구득도합리적예측성지표.방법 52례Ⅲ기비소세포폐암환자접수삼유괄형방료급NP방안동기화료,방료처방제량60 Gy,1.8-2 Gy/차,5차/주,공30～34차,우방료개시적제1주、제5주급여동기화료,관찰급성방사성식관염발생정황병진행단인소、다인소급ROC곡선분석.결과 식관염총발생솔위84.6%(44/52),기중0급8례(15.3%).1급16례(30.8%),2급12례(23.1%),3급16례(30.8%),무4급발생.상관인소분석급Binary Logistic단인소분석현시.식관접수적평균제량(MED)、LETT_(40)、LETT_(45)、LETT_(50)、LETT_(55)、LETT_(60)、V_(40)、V_(45)、V_(50)、V_(55)、V_(60)균여방사성식관염구유교호적상관성,능예측급성방사성식관염적발생(X~2=7.355～8.690,P<0.05);다인소분석결과제시,식관V_(55),시예측방사성식관염최유개치적지표.ROC곡선(수시자공작특정곡선)분석결과현시,곡선하면적위0.725(P=0.006),곡선계치위V_(55)=26%,식관V_(55),>26%조여≤26%조2급급이상방사성식관염적발생솔분별위67.7%(21/31)화33.3%(7/21).결론 대국부만기NSCLC진행삼유괄형방료급동기화료,가출현교엄중적방사성식관염,식관MED、LETT_(40)、LETT_(45)、LETT_(50)、LETT_(55)、LETT_(60)、V_(40)、V_(45)、V_(50)、V_(55)、V_(60)가이교호지예측방사성식관염적발생,V_(55)가능시최유개치적예측성지표.당V_(55)>26%시,2、3급급성방사성식관염적발생솔가능회명현증가.
Objective To investigate the radiation toxicity for esophagus in stage Ⅲ NSCLC treatment using three dimensional conformal radiotherapy (3D CRT) combined with concurrent chemotherapy,and to obtain the relevant factors that can be regareded as predictors to complications of esophagus.Methods From Sep 2006 to Dec 2008,52 patients with stage Ⅲ NSCLC received 3D CRT plus concutrent chemotherapy of navelbine + cisplatin (NP) with prescription of 60 Gy/30 fractions,and chemotherapy at 1 and 5 week.Univariate and multivariate analysis and ROC (receiver operating characteristic curves) were performed to assess the association of radiation-induced esophagitis and the correlated factors.Results Of all the patients,84.6%(44/52) developed radiation esophagitis including grade 1 for 16 patients,grade 2 for 12 patients and grade 3 for 16 patients,without grade 4 developed.The correlative factors coreprised of mean esophagus dose (MED),the LETT_(40),LETT_(45),LETT_(50),LETT_(55),LETT_(60),V_(40)、V_(45)、V_(50)、V_(55)、and V_(60) of esophagus according to Spearman correlative analysis,and all the 11 factors could predict radiation esophagitis according to univariate analysis (X~2=7.355-8.690,P<0.05).Only V_(55) was found independently associated with esophagitis according to multivariate analysis.ROC analysis indicated that the cut-off point of the curve was 26% with the area under ROC curve of 0.725(P=0.006).For the patients with esophageal V_(55)>26%,21 of 31(67.7%) developed 2 or 3 grade radiation esophagitis,while for the patients with V_(55) ≤26%,only 7 of 21(33.3%) developed severe esophagitis.Conclusions 3D CRT combined with concurrent chemotherapy for patients with stage Ⅲ NSCLC may develop severe radiation esophagitis.Dosimetric parameters (MED,LETT_(40),LETT_(45),LETT_(50),LETT_(55),LETT_(60),V_(40)、V_(45)、V_(50)、V_(55)、and V_(60)) were important to predict the radiation-induced esophagitis.According to multivariate analysis,C_(55) may be the most valuable predictor.When the value of V_(55) excluded 26%,the probability of esophagitis of grade 2 and 3 may increase notably.
