Acute esophageal toxicity in non-small cell lung cancer patients after high dose conformal radiotherapy
Acute esophageal toxicity in non-small cell lung cancer patients after high dose conformal radiotherapy
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DOI：
10.1016/j.radonc.2005.03.021
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发表时间：
2005-05-01
影响因子：
5.7
通讯作者：
Lebesque, J
中科院分区：
文献类型：
--
作者：
Belderbos, J;Heemsbergen, W;Lebesque, J
背景与目的：探讨非小细胞肺癌(NSCLC)单纯放射治疗(RT)和化疗联合放射治疗(CRT)患者的急性食道毒性与剂量学和临床参数的关系。74例患者接受大剂量RT照射，45例患者接受序贯CRT(吉西他滨/顺铂)治疗，37例患者同时接受CRT治疗(顺铂每日6 mg/m(2))。放疗剂量49.5~94.5Gy2.25~2.75Gy次/次，总治疗时间5~6周。对所有患者的最大急性食道毒性(RTOG/EORTC标准)进行评分，并与剂量-体积参数以及临床和治疗相关参数相关。所有参数在二元Logistic回归模型中进行单变量和多变量检验。结果：42例患者中，27%(n=42)发生2级以上的急性食道毒性，其中9例发生3级毒性，1例发生4级毒性。在多变量分析中，预测急性食道毒性的最重要的临床参数是同时使用CRT。最重要的剂量学参数是接受至少35Gy射线照射的食道体积。未接受同期CRT的患者数据符合Lyman-Kutcher-Burman正常组织并发症概率模型。非同期治疗患者的数据与该模型的最佳拟合度如下：TD50=47Gy41-60Gyn=0.69(0.18-6.3)，m=0.36(0.25-0.55)，其中括号之间的数字表示95%的可信区间。接受序贯CRT治疗的患者的急性食道毒性没有显著增加。结论：并发CRT和接受至少35Gy量都是急性食道毒性的预测因素。(C)2005爱思唯尔爱尔兰有限公司。保留所有权利。
Background and purpose: To correlate acute esophageal toxicity with dosimetric and clinical parameters for non-small cell lung cancer (NSCLC) patients treated with radiotherapy (RT) alone or with chemo-radiotherapy (CRT).Patients and methods: We analyzed the data of 156 patients with medically inoperable or locally advanced NSCLC. Seventy-four patients were irradiated with high dose RT only, 45 patients with sequential CRT (Gemicitabine/Cisplatin) and 37 patients with concurrent CRT (Cisplatin daily 6 mg/m(2)). The radiation dose delivered ranged from 49.5 to 94.5 Gy (2.25-2.75 Gy per fraction) with an overall treatment time of 5-6 weeks. For all patients the maximal acute esophageal toxicity (RTOG/EORTC criteria) was scored and related to dose-volume parameters, as well as to clinical and treatment-related parameters. All parameters were tested univariable and multivariable in a binary logistic regression model. The toxicity data of a homogeneous subgroup was fitted to the Lyman-Kutcher-Burman model.Results: Grade 2 acute esophageal toxicity or higher occurred in 27% (n = 42) of the patient population of which nine patients developed grade 3 toxicity and one patient grade 4. All 10 patients with grade >= 3 esophageal toxicity received concurrent CRT. At multivariable analysis, the most significant clinical parameter to predict acute esophageal toxicity was the concurrent use of CRT. The most significant dosimetric parameter was the esophagus volume that received at least 35 Gy. The data of the patients who did not receive concurrent CRT were well described by the Lyman-Kutcher-Burman normal tissue complication probability model. The optimal fit of the data of non-concurrent treated patients to this model was obtained using the following values for the parameters: TD50 = 47 Gy (41-60 Gy), n = 0.69 (0.18-6.3) and m = 0.36 (0.25-0.55) where the numbers between brackets denote the 95% confidence interval. Acute esophageal toxicity was not significantly increased for patients treated with sequential CRT.Conclusion: Both concurrent CRT and the volume that receives at least 35 Gy were predictors of acute esophageal toxicity. (c) 2005 Elsevier Ireland Ltd. All rights reserved.