Dosimetric and clinical predictors for radiation-induced esophageal injury
Dosimetric and clinical predictors for radiation-induced esophageal injury
复制标题
DOI：
10.1016/j.ijrobp.2004.06.014
复制
发表时间：
2005-02-01
影响因子：
7
通讯作者：
Marks, LB
中科院分区：
文献类型：
--
作者：
Ahn, SJ;Kahn, D;Marks, LB
目的：评价非小细胞肺癌放疗(RT)后食道损伤的临床和三维剂量学参数。方法与材料：回顾1992~2001年收治的254例非小细胞肺癌患者的临床资料。提取了描述食道剂量的各种指标。采用放射治疗肿瘤学组的食道损伤分级标准。所有患者的中位随访时间为43个月(0.5-120个月)。采用Logistic回归分析、列联表分析和Fisher‘s精确检验进行统计学分析。结果：254例患者中199例(78%)发生急性毒性反应。对于2级或更差的急性毒性，每日两次RT、年龄、氮气或更差的结节阶段，以及大多数剂量学参数都是可预测的。238例患者中有17例(7%)出现晚期毒性反应。晚期毒性发生的中位时间和最长时间分别为放疗后5个月和40个月。晚期毒性发生率分别为2%、3%、17%、26%和100%，急性毒性为0、1、2、3和4级。对于晚期毒性，急性毒性的严重程度是最具预测性的。结论：各种剂量学参数都可以预测急性和晚期食道损伤。剂量学参数之间的强相关性阻止了这些量度的预测能力之间的比较。急性损伤的存在是晚期损伤发展的最具预测性的因素。还需要更多的研究来更好地确定RT诱导的食道损伤的预测因素。(C)2005年爱思唯尔公司。
Purpose: To evaluate the clinical and three-dimensional dosimetric parameters associated with esophageal injury after radiotherapy (RT) for non-small-cell lung cancer.Methods and Materials: The records of 254 patients treated for non-small-cell lung cancer between 1992 and 2001 were reviewed. A variety of metrics describing the esophageal dose were extracted. The Radiation Therapy Oncology Group toxicity criteria for grading of esophageal injury were used. The median follow-up time for all patients was 43 months (range, 0.5-120 months). Logistic regression analysis, contingency table analyses, and Fisher's exact tests were used for statistical analysis.Results: Acute toxicity occurred in 199 (78%) of 254 patients. For acute toxicity of Grade 2 or worse, twice-daily RT, age, nodal stage of N2 or worse, and most dosimetric parameters were predictive. Late toxicity occurred in 17 (7%) of 238 patients. The median and maximal time to the onset of late toxicity was 5 and 40 months after RT, respectively. Late toxicity occurred in 2%, 3%, 17%, 26%, and 100% of patients with acute Grade 0, 1, 2, 3, and 4 toxicity, respectively. For late toxicity, the severity of acute toxicity was most predictive.Conclusion: A variety of dosimetric parameters are predictive of acute and late esophageal injury. A strong correlation between the dosimetric parameters prevented a comparison between the predictive abilities of these metrics. The presence of acute injury was the most predictive factor for the development of late injury. Additional studies to define better the predictors of RT-induced esophageal injury are needed. (C) 2005 Elsevier Inc.