天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (2): 159-162.doi: 10.11958/20181557

• 临床研究 • 上一篇    下一篇

调强放疗模式下食管癌患者急性放射性肺损伤的影响因素分析

吴万艳1,2 ， 谭遥1 ， 肖楠1 ， 刘燕1 ， 伊斯刊达尔 ·阿布力米提1△   

  1. 1新疆医科大学第三临床医学院 （附属肿瘤医院） 胸腹放疗科； 2鹤峰县中心医院
  • 收稿日期:2018-10-15 修回日期:2018-12-28 出版日期:2019-02-15 发布日期:2019-02-15
  • 通讯作者: 伊斯刊达尔·阿布力米提 E-mail:iskandara@126.com
  • 基金资助:
    新疆维吾尔自治区自然科学基金

Analysis of influencing factors of radiation-induced lung injury in patients with esophageal cancer treated by IMRT

WU Wan-yan1, 2 , TAN Yao1 , XIAO Nan1 , LIU Yan1 , ISLET Dahl 1△   

  1. 1 Department of Chest and Abdominal Radiotherapy, the Third Clinical Medical College of Xinjiang Medical University (the Affiliated Cancer Hospital), Urumqi 830011, China; 2 Hefeng Country Central Hospital
  • Received:2018-10-15 Revised:2018-12-28 Published:2019-02-15 Online:2019-02-15

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摘要： 目的 探讨调强放射治疗模式下食管癌患者出现急性放射性肺损伤的影响因素。方法 回顾分析2014 年1月—2016年12月在新疆医科大学附属肿瘤医院接受调强放疗的食管癌患者233例， 按照是否发生急性放射性肺损伤分组， 对发生放射性肺损伤的影响因素进行预测分析。临床资料包括年龄、 性别、 T分期、 淋巴结有无转移、 病理类型、 病变位置、 病变长度、 化疗模式、 KPS评分、 基础肺疾病、 糖尿病、 吸烟史； 物理学参数包括双肺V5、 V10、 V15、 V20、 V30、 全肺平均剂量 （MLD）、 肿瘤靶区 （GTV） 体积、 两肺体积、 GTV体积与两肺体积比值、 放射野数、 处方剂量。采用Logistic回归分析筛选放射性肺损伤的危险因素。结果 233例患者中63例 （27%） 出现急性放射性肺损伤， 其中≥2级急性放射性肺损伤25例 （10.7%）。急性RILI组与无RILI组间淋巴结转移、 GTV体积、 GTV体积与两肺体积比值、 MLD、 双肺V5、 V10、 V15、 V20、 V30、 处方剂量比较差异有统计学意义。多因素分析显示， 双肺V5≥63.15% （OR= 1.022， 95%CI： 1.003～1.041）、 V30≥5.35% （OR=2.693， 95%CI： 1.159～6.010） 是发生急性放射性肺损伤的危险因素（P＜0.05）。结论 评估食管癌调强放疗治疗计划时， 应充分考虑临床特征、 双肺V5、 V30等物理学指标， 尽量降低放射性肺损伤的风险。

关键词: 食管肿瘤, 放射疗法, 调强适形, 辐射性肺炎, 放射性肺损伤

Abstract: Objective To explore the influencing factors of radiation-induced lung injury (RILI) in esophageal cancer treated with intensity modulated radiation therapy (IMRT). Methods Clinical data of 233 patients with esophageal cancer treated with IMRT in Tumor Hospital affiliated to Xinjiang Medical University from January 2014 to December 2016 were analyzed retrospectively. All of the patients were divided into 2 groups according to whether acute radiation lung injury occurred: with RILI and without RILI. The influencing factors of radiation-induced lung injury were analyzed. Clinical data included age, sex, T staging, lymph node metastasis, pathological type, tumor location, tumor length, chemotherapy mode, KPS score, basic lung disease, diabetes and smoking history. Physical parameters of radiotherapy included double lung V5, V10, V15, V20 and V30, mean lung dose (MLD), gross tumor volume (GTV), two lung volume, GTV volume and two lung volume ratio, field number of irradiated and prescription dose. The risk factors of radiation-induced lung injury were screened by Logistic regression analysis. Results In all groups, there were 63 (27%) patients with RILI, and 25 (10.7%) patients with grade ≥2 RILI. Univariate analysis showed that the positive lymph nodes, GTV volume, GTV volume and two lung volume ratio, MLD, and double lung V5, V10, V15, V20, V30 and prescription dose were significantly different between the two groups. Multivariate analysis showed that V5 ≥63.15% (OR=1.022, 95%CI: 1.003-1.041) and V30 ≥5.35% (OR= 2.693, 95%CI: 1.159-6.010) were risk factors for RILI (P＜0.05). Conclusion The full account of the clinical characteristics and the physical indexes such as V5 and V30 should be considered to minimize the risk of RILI, when evaluating the treatment plan of intensity modulated radiotherapy for esophageal cancer.

Key words:  esophageal neoplasms, radiotherapy, intensity-modulated, radiation pneumonitis, radiation-induced lung injury