适形放疗晚期肺癌放射性食管炎相关因素分析

目的分析Ⅲ～Ⅳ期非小细胞肺癌三维适形放射治疗中急性放射性食管损伤（AE）的发生率及其相关因素。方法选择2006年3月至2008年11月行三维适形放疗的晚期肺癌患者195例,男165例,女30例。其中有79例患者行同步放化疗,中位等效生物剂量为72.0Gy,观察AE的发生率,采用单因素和多因素变量分析方法,对选择的临床和剂量学因素进行与2级以上AE的相关性分析。结果 2级AE38例（19.5%）,3级AE25例（12.8%）。单变量分析显示,临床因素中疗前体重下降≥5%、同时化放疗、淋巴结分期、临床类型和后程超分割放疗与2级以上AE有相关性,剂量学指标中食管受照最大剂量、平均剂量、V20、V25、V30、V35、V40、V45、V50、V55、V60的差异均有统计学意义（P〈0.001）,同时放化疗和V55在BinaryLogistic多因素分析中的差异有统计学意义。结论期非小细胞肺癌三维适形放射治疗中,同时化放疗和V55是预测AE最有价值的指标。

Analysis of factors predicting radiation esophagitis in the treatment of three-dimensional conformal radiotherapy for advanced lung cancer

Objective To analysis the incidence of acute radiation esophagitis（ AE） and analyze the factors as predictors of acute radiation esophagitis in the treatment of three dimensional conformal radiotherapy （ 3DCRT） for stage Ⅲ-Ⅳ non-small cell lung cancer. Methods We choiced 195 patients of nonsmall cell lung cancer treated with 3DCRT between March 2006 and November 2008. The population consisted of 165 men and 30 women,79 cases of these patients were treated with concurrent chemotherapy （ CCT） . The median biologic effective dose of radiotherapy was 72. 0Gy. Besides to observe the incidence rate of the AE. The clinical and dosimetric factors associated with grade 2 or worse AE were analyzed using univariate and multivariate binary logistic analysis. Results AE was observed in thirty-eight cases（ 19. 5% ） with grade 2 and twenty-five cases（ 12. 8% ） with grade 3. Univariate analysis showed that clinical factors,such as pretreatment weight loss≥5% ,CCT,lymph node stage,and the use of late-course hyperfractionated radiotherapy were significantly associated with grade 2 and 3 AE. Dose volume parameters of esophagus including maximal esophageal dose,mean esophageal dose,V20,V25,V30,V35,V40,V45,V50,V55,V60 were also associated with AE. On multivariate forward step-wald logistic analysis,CCT and V55 emerged as the statistically most significant factors of AE（ P 0. 001） . Conclusion CCT and V55 were most valuable predictors of grade 2 or worse AE in the treatment of 3D-CRT for stage Ⅲ ～ Ⅳ NSCLC.