Dosimetric predictors of radiation-induced pericardial effusion in esophageal cancer.
Dosimetric predictors of radiation-induced pericardial effusion in esophageal cancer.
复制标题
食管癌辐射引起的心包积液的剂量学预测因子。
DOI：
10.1007/s00066-017-1127-8
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发表时间：
2017
影响因子：
3.1
通讯作者：
Kimura K
中科院分区：
文献类型：
--
作者：
Ogino I;Watanabe S;Sakamaki K;Ogino Y;Kunisaki C;Kimura K
目的探讨食管癌同步放化疗患者心包及心脏的剂量-体积参数，以降低放化疗患者发生放射性心包积液（PE）及症状性PE （SPE）的风险。方法对303例食管癌患者中的86例，在同步放化疗后至少24个月进行CT随访。应用Cox比例风险回归分析临床因素（包括心脏病危险因素、剂量学因素、放疗后PE和SPE发生率）之间的相关性。根据与食道的距离进行分区，研究具有最高危险比的显著剂量学因素。结果49例患者发生spe。单因素分析显示，平均心脏剂量、心脏V5-V55、平均心包剂量、心包v5 - v50对PE的发生率均有显著影响。此外，在多变量分析中，体表面积与PE的发生率相关。5例患者发生3级和4级SPE。心包v50和d10对SPE的发生率有显著影响。SPE患者心包v50值为17.1 ~ 21.7%。影响SPE发生的因素为食管3cm以内和4cm以内心包带v50。结论大范围的心脏及心包辐射剂量与PE的发生有关。同步放化疗的食管癌患者心包V50≤17%对于避免症状性PE很重要。
PurposeTo evaluate the dose–volume parameters of the pericardium and heart in order to reduce the risk of radiation-induced pericardial effusion (PE) and symptomatic PE (SPE) in esophageal cancer patients treated with concurrent chemoradiotherapy.MethodsIn 86 of 303 esophageal cancer patients, follow-up CT was obtained at least 24 months after concurrent chemoradiotherapy. Correlations between clinical factors, including risk factors for cardiac disease, dosimetric factors, and the incidence of PE and SPE after radiotherapy were analyzed using Cox proportional hazard regression analysis. Significant dosimetric factors with the highest hazard ratios were investigated using zones separated according to their distance from esophagus.ResultsPE developed in 49 patients. Univariate analysis showed the mean heart dose, heart V5–V55, mean pericardium dose, and pericardium V5–V50to all significantly affect the incidence of PE. Additionally, body surface area was correlated with the incidence of PE in multivariate analysis. Grade 3 and 4 SPE developed in 5 patients. The pericardium V50and pericardium D10significantly affected the incidence of SPE. The pericardium V50in patients with SPE ranged from 17.1 to 21.7%. Factors affecting the incidence of SPE were the V50of the pericardium zones within 3 cm and 4 cm of the esophagus.ConclusionA wide range of radiation doses to the heart and pericardium were related to the incidence of PE. A pericardium V50≤ 17% is important to avoid symptomatic PE in esophageal cancer patients treated with concurrent chemoradiotherapy.