Association of Clinical and Dosimetric Factors with Postoperative Pulmonary Complications in Esophageal Cancer Patients Receiving Intensity-Modulated Radiation Therapy and Concurrent Chemotherapy Followed by Thoracic Esophagectomy
Association of Clinical and Dosimetric Factors with Postoperative Pulmonary Complications in Esophageal Cancer Patients Receiving Intensity-Modulated Radiation Therapy and Concurrent Chemotherapy Followed by Thoracic Esophagectomy
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DOI：
10.1245/s10434-009-0401-0
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发表时间：
2009-06-01
影响因子：
3.7
通讯作者：
Cheng, Jason Chia-Hsien
中科院分区：
文献类型：
--
作者：
Hsu, Feng-Ming;Lee, Yung-Chie;Cheng, Jason Chia-Hsien
为探讨食管癌胸段切除术后新辅助化疗和调强放疗（IMRT）的临床/剂量学因素与术后肺部并发症（PPC）的关系，分析了52例接受IMRT联合化疗的食管癌患者的资料。43例患者化疗以紫杉烷为基础，9例患者化疗以5-氟尿嘧啶为基础。采用3-5射束排列进行IMRT（40-45戈伊，中位数40戈伊，每次1.8-2戈伊）。手术包括开放式或微创食管切除术。剂量学参数由治疗计划软件计算的肺剂量-体积直方图生成。PPC定义为术后30天内的肺炎或呼吸功能不全。PPC发生率为34.6%。无患者死于PPC。2名患者（3.8%）依赖呼吸机。在单变量分析中，术前1秒用力呼气量（FEV 1）和术前用力肺活量与PPC显著相关（分别为P = 0.02和0.04）。没有剂量测定因素预测PPC的发展。在51例接受右胸手术的患者中，接受15戈伊照射的右肺绝对备用容积较高与PPC显著相关（P = 0.03）。在多因素分析中，术前FEV 1是与PPC相关的唯一独立因素（P = 0.002），术前FEV 1而不是放化疗前预测PPC的发生。对于接受右胸手术的患者，减少照射的右肺的绝对体积可能会降低PPC的风险。
To investigate the association between clinical/dosimetric factors and postoperative pulmonary complications (PPC) in esophageal cancer patients undergoing neoadjuvant chemotherapy and intensity-modulated radiation therapy (IMRT) followed by thoracic esophagectomy.The data from 52 patients receiving combined modality treatment were analyzed. Chemotherapy was taxane-based in 43 and 5-fluorouracil-based in 9 patients. IMRT (40-45 Gy, median 40 Gy, at 1.8-2 Gy per fraction) was given using a 3-5-beam arrangement. Surgery consisted of open or minimally invasive esophagectomy. The dosimetric parameters were generated from lung dose-volume histogram computed by the treatment planning software. PPC was defined as pneumonia or respiratory insufficiency within 30 days after surgery. Statistical correlations were analyzed between clinical/dosimetric factors and PPC.The incidence of PPC was 34.6%. No patients died of PPC. Two patients (3.8%) became ventilator dependent. In univariate analyses, preoperative forced expiratory volume in 1 s (FEV1) and forced vital capacity before surgery were significantly associated with PPC (P = 0.02 and 0.04, respectively). None of the dosimetric factors predicted development of PPC. For the 51 patients undergoing right transthoracic surgery, higher absolute spared volume of the right lung receiving 15 Gy was significantly associated with PPC (P = 0.03). In multivariate analysis, preoperative FEV1 was the only independent factor associated with PPC (P = 0.002).Preoperative rather than prechemoradiation FEV1 predicts development of PPC. Reducing the absolute volume of the right lung that is irradiated might decrease the risk of PPC for patients receiving right transthoracic surgery.