CAJ | 학술논문

目的：观察局部晚期非小细胞肺癌（ NSCLC）三维适形放疗所致放射性食管炎的相关影响因素。方法回顾性分析2001年1月至2008年12月期间接受放疗的局部晚期非小细胞肺癌203例，其中男性163例，女性40例，中位年龄63岁；Ⅲa期79例，Ⅲb期124例；中位等效处方剂量62 Gy（范围50～78 Gy），其中，单纯放疗74例，序贯放化疗45例，同期放化疗87例。急性放射性食管炎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。对与放射性食管炎相关的临床因素及物理参数进行相关性分析。结果203例局部晚期NSCLC放疗后，发生1级急性放射性食管炎者47例，2级37例，3级4例，≥2级放射性食管炎发生率为20?2％（41/203）。单因素分析表明，年龄、化疗（单纯放疗/序贯放化疗/同期放化疗）、GTV、PTV、PTV和肺的平均剂量、食管最大剂量和平均剂量、食管V40、V45、V50、V55、V60、全周食管接受剂量＞45 Gy的食管长度（LETT45）和LETT50与≥2级放射性食管炎相关（r＝-0?162～0?235，P＜0?05）；而性别、肿瘤位置、吸烟与否、T、N分期、临床分期、放疗剂量、分割方式、GTV平均剂量、LETT55、LETT60与≥2级放射性食管炎无明显相关（r＝-0?106～0?122， P＞0?05）。将以上所有因素进行多因素分析，结果仅化疗和食管V45是≥2级放射性食管炎发生的独立危险因素（Wald＝4?626和9?882，P＜0?05）。结论局部晚期非小细胞肺癌同期放化疗明显增加放射性食管炎；DVH中物理学参数可用于预测和评价放射性食管炎的发生，其中食管V45可能是最有价值的预测指标。
목적：관찰국부만기비소세포폐암（ NSCLC）삼유괄형방료소치방사성식관염적상관영향인소。방법회고성분석2001년1월지2008년12월기간접수방료적국부만기비소세포폐암203례，기중남성163례，녀성40례，중위년령63세；Ⅲa기79례，Ⅲb기124례；중위등효처방제량62 Gy（범위50～78 Gy），기중，단순방료74례，서관방화료45례，동기방화료87례。급성방사성식관염채용미국종류방사치료협작조（ RTOG）표준，제량체적직방도（ DVH）평고물리삼수。대여방사성식관염상관적림상인소급물리삼수진행상관성분석。결과203례국부만기NSCLC방료후，발생1급급성방사성식관염자47례，2급37례，3급4례，≥2급방사성식관염발생솔위20?2％（41/203）。단인소분석표명，년령、화료（단순방료/서관방화료/동기방화료）、GTV、PTV、PTV화폐적평균제량、식관최대제량화평균제량、식관V40、V45、V50、V55、V60、전주식관접수제량＞45 Gy적식관장도（LETT45）화LETT50여≥2급방사성식관염상관（r＝-0?162～0?235，P＜0?05）；이성별、종류위치、흡연여부、T、N분기、림상분기、방료제량、분할방식、GTV평균제량、LETT55、LETT60여≥2급방사성식관염무명현상관（r＝-0?106～0?122， P＞0?05）。장이상소유인소진행다인소분석，결과부화료화식관V45시≥2급방사성식관염발생적독립위험인소（Wald＝4?626화9?882，P＜0?05）。결론국부만기비소세포폐암동기방화료명현증가방사성식관염；DVH중물이학삼수가용우예측화평개방사성식관염적발생，기중식관V45가능시최유개치적예측지표。
Objective To explore radiation-induced esophagitis and its related factors in the patients with local advanced non-small cell lung cancer ( NSCLC ) which were treated with three-dimensional conformal radiation therapy (3D-CRT). Methods From January 2001 to December 2008, 203 patients who suffered from stageⅢNSCLC were achieved, including 163 males and 40 females, with a median age of 63 years old, while 79 cases were in stageⅢa and 124 in stageⅢb . The equivalent median dose of tumor was 62 Gy( range of 50-78 Gy) . Among them, 74 cases were administered with radiotherapy alone, 45 with sequential radiotherapy and chemotherapy, 87 cases with concurrent radiochemotherapy. Radiation esophagitis was evaluated with RTOG standard. The dosimetric parameters was estimated from dose volume histogrma ( DVH ) . The clinical and dosimetric parameters of radiation esophagitis were evaluated by spearman correlatived univariate and Logistic multivariable analysis. Results After radiotherapy, out of 203 patients, 87 had acute radiation esophagitis(RE), 47 in grade 1, 37 in grade 2, and 3 in grade 3 RE. According to spearman correlatived analysis, the correlatived factors included ages, chemotherapy, GTV, PTV, the mean doses of PTV and lung, the max and mean dose of esophagus, V40 , V45 ,V50 ,V55 ,V60 , length of esophagus( total circumference) treated with 45 Gy ( LETT45 ) , and LETT50 ( r=-0. 162-0. 235,P<0. 05). All the 14 factors had good correlation with RE in univariate analysis. But for other factors,such as gender, site of tumor, smoking, T, N, clinical stage, equivalent dose of tumor, style of radiation, the mean dose of GTV, LETT55 and LETT60 , there were not correlation with ≥grade 2 RE with univariate analysis(r= -0. 106-0. 122, P>0. 05). There were 21 factors, such as gender, age, smoking, clinical stage, site of tumor, chemotherapy, GTV, PTV, mean dose of PTV and lung, max and mean dose of esophagus, V40 -V60 of esophagus, LETT45-60 , incorporated into multivariable analysis, only chemotherapy and V45 of esophagus were independent predicted factors(Wald=4. 626, 9?882, P<0. 05). Conclusions In local advanced NSCLC after 3D-CRT, chemotherapy ( especially concurrent radiochemotherapy) could increase radiation-induced esophagitis. The parameter of DVH could also be used to predict radiation-induced esophagitis, V45 of esophagus may be the most valuable predictor.