Risk factors of radiation-induced acute esophagitis in non-small cell lung cancer patients treated with concomitant chemoradiotherapy.
Risk factors of radiation-induced acute esophagitis in non-small cell lung cancer patients treated with concomitant chemoradiotherapy.
复制标题
同步放化疗的非小细胞肺癌患者放射性急性食管炎的危险因素。
DOI：
10.1186/1748-717x-9-54
复制
发表时间：
2014-02-15
期刊：
影响因子：
--
通讯作者：
Ying G
中科院分区：
文献类型：
--
作者：
Zhang Z;Xu J;Zhou T;Yi Y;Li H;Sun H;Huang W;Wang D;Li B;Ying G
分析同期放化疗治疗的非小细胞肺癌（NSCLC）患者发生急性食管炎（AE）的临床和剂量学危险因素。回顾性分析了76例接受同步放化疗的NSCLC患者。41例患者接受长春瑞滨/顺铂（VC）同步放化疗，35例患者接受多西他赛/顺铂（DC）同步放化疗。根据放射治疗肿瘤组（RTOG）的标准对AE进行分级。分析了以下临床和剂量测定参数：性别、年龄、临床分期、Karnofsky体能状态（KPS）、治疗前体重减轻、伴随化疗药物（CCA）（VC vs. DC），接受≥20（V20）、≥30（V30）、≥40（V40）、≥50（V50）和≥60戈伊（V60）治疗的食管体积百分比，以及输送到食管的最大剂量（Dmax）和平均剂量（Dmean）。采用单因素和多因素Logistic回归分析各因素与AE的关系。70例患者发生AE（1级，19例患者; 2级，36例患者; 3级，15例患者）。多因素Logistic回归分析显示，V40是与≥2级AE相关的唯一统计学显著性因素（p<0.001，OR = 1.159）。V40 <23%时发生≥2级AE的风险为33.3%（10/30），V40 ≥23%时增加至89.1%（41/46）（p<0.001）。CCA（p =0.01; OR = 9.686）和V50（p<0.001; OR = 1.122）与3级AE最显著相关。V50 <26.5%时，3级AE的风险为6.7%（3/45），当V50 ≥26.5%时，3级AE的风险增加至38.7%（12/31）（p = 0.001）。线性回归分析显示，V50和CCA是影响AE持续时间的独立因素。与DC相比，接受VC伴随化疗的患者发生3级AE的风险降低，持续时间缩短。伴随化疗药物对AE有潜在影响。与使用DC相比，VC伴随化疗导致AE的风险降低。食管V40和V50可分别预测≥2级和≥3级AE。
To analyze the clinical and dosimetric risk factors of acute esophagitis (AE) in non-small-cell lung cancer (NSCLC) patients treated with concomitant chemoradiotherapy. Seventy-six NSCLC patients treated with concomitant chemoradiotherapy were retrospectively analyzed. Forty-one patients received concomitant chemoradiotherapy with vinorelbine/cisplatin (VC), 35 with docetaxel/cisplatin (DC). AE was graded according to criteria of the Radiation Therapy Oncology Group (RTOG). The following clinical and dosimetric parameters were analyzed: gender, age, clinical stage, Karnofsky performance status (KPS), pretreatment weight loss, concomitant chemotherapy agents (CCA) (VC vs. DC), percentage of esophagus volume treated to ≥20 (V20), ≥30 (V30), ≥40 (V40), ≥50 (V50) and ≥60 Gy (V60), and the maximum (Dmax) and mean doses (Dmean) delivered to esophagus. Univariate and multivariate logistic regression analysis were used to test the association between the different factors and AE. Seventy patients developed AE (Grade 1, 19 patients; Grade 2, 36 patients; and Grade 3, 15 patients). By multivariate logistic regression analysis, V40 was the only statistically significant factor associated with Grade ≥2 AE (p<0.001, OR = 1.159). A V40 of <23% had a 33.3% (10/30) risk of Grade ≥2 AE, which increased to 89.1% (41/46) with a V40 of ≥23% (p<0.001). CCA (p =0.01; OR = 9.686) and V50 (p<0.001; OR = 1.122) were most significantly correlated with grade 3 AE. A V50 of <26.5% had a 6.7% (3/45) risk of Grade 3 AE, which increased to 38.7% (12/31) with a V50 of ≥26.5% (p = 0.001). On the linear regression analysis, V50 and CCA were significant independent factors affecting AE duration. Patients who received concomitant chemotherapy with VC had a decreased risk of grade 3 AE and shorter duration compared with DC. Concomitant chemotherapy agents have potential influence on AE. Concomitant chemotherapy with VC led to lower risk of AE compared with that using DC. V40 and V50 of esophagus can predict grade ≥2 and ≥3 AE, respectively.