食管鳞癌调强放疗后急性放射性肺炎发生的临床和剂量学相关因素分析
|
摘要
目的:分析食管癌患者接受调强放疗(intensity modulated radiation theapy,IMRT)的体积剂量参数与放射性肺炎发生间的相关性,为临床治疗计划的制定提供参考依据。方法:回顾性分析2013年1月至2016年12月我院88例接受食管癌IMRT患者的资料,收集临床数据和体积剂量参数V5～V40、肺平均剂量(mean lung dose, MLD)、全肺体积(total lung volume, TLV)、计划靶区(planning target volume,PTV),并与放疗后发生放射性肺炎情况进行相关性分析。结果:中位随访18.7个月后显示,接受IMRT治疗患者的放射性肺炎中位发生时间为42 d,其中25例(28.4%)患者发生1度放射性肺炎,13例(14.8%)发生2度放射性肺炎,1例(1.1%出现3度放射性肺炎,无4度以上放射性肺炎发生。单因素分析显示,放射治疗的模式、食管癌根治术及剂量学参数V5、V10、V20、MLD与1度放射性肺炎的发生间具有相关性(P<0.05),仅剂量学参数V5、V10、V20、MLD与2度放射性肺炎的发生相关(P<0.05)。多因素分析显示,V5是发生1度放射性肺炎的独立预测因素,V10是发生2度以上放射性肺炎的独立预测因素,未发现与2度以上放射性肺炎相关的临床相关因素。结论:食管癌接受IMRT治疗患者发生放射性肺炎的危险与V5、V10密切相关,制定IMRT治疗计划时应注意对低剂量体积参数的限制。
Objective: To analyze the clinical and dosimetric factors associated with radiation-induced pneumonitis(RIP) in esophageal carcinoma patients treated with intensity modulated radiation therapy(IMRT) for developing a predictive model of RIP risk. Methods: Eighty-eight patients with histologically con覱rmed esophageal carcinoma treated with IMRT from January 2013 to December 2016 were reviewed retrospectively. Clinical factors and dosimetric parameters were collected, and their correlations with risk of RIP were analyzed. Results: In total, twenty-five cases(28.4%) with grade 1 RIP, 13(14.8%) with grade 2 RIP, and1(1.1%) with grade 3 RIP(CTC 4.0) were observed. No grade 4 RIP was found.In univariate analysis, therapy modal of radiation, esophagectomy and dosimetric parameters V5, V10, V20 and mean lung dose(MLD) were significant factors for the development of RIP≥G1(P<0.05). The V5, V10, V20, MLD were proved to be significant factors for the development of RIP≥G2(P<0.05). By multivariate analysis, V5 was the only independent predictive factors for the development of RIP≥G1(P<0.05); V10 was the only independent predictive factor for the development of RIP≥G2(P<0.05). Conclusions: In comparison with MLD and V20, the widely used dosimetric parameters, our study showes that dosimetric parameters V5 and V10 could be the better predictor of RIP under the background of IMRT for esophageal carcinoma.
Objective: To analyze the clinical and dosimetric factors associated with radiation-induced pneumonitis(RIP) in esophageal carcinoma patients treated with intensity modulated radiation therapy(IMRT) for developing a predictive model of RIP risk. Methods: Eighty-eight patients with histologically con覱rmed esophageal carcinoma treated with IMRT from January 2013 to December 2016 were reviewed retrospectively. Clinical factors and dosimetric parameters were collected, and their correlations with risk of RIP were analyzed. Results: In total, twenty-five cases(28.4%) with grade 1 RIP, 13(14.8%) with grade 2 RIP, and1(1.1%) with grade 3 RIP(CTC 4.0) were observed. No grade 4 RIP was found.In univariate analysis, therapy modal of radiation, esophagectomy and dosimetric parameters V5, V10, V20 and mean lung dose(MLD) were significant factors for the development of RIP≥G1(P<0.05). The V5, V10, V20, MLD were proved to be significant factors for the development of RIP≥G2(P<0.05). By multivariate analysis, V5 was the only independent predictive factors for the development of RIP≥G1(P<0.05); V10 was the only independent predictive factor for the development of RIP≥G2(P<0.05). Conclusions: In comparison with MLD and V20, the widely used dosimetric parameters, our study showes that dosimetric parameters V5 and V10 could be the better predictor of RIP under the background of IMRT for esophageal carcinoma.
引文
[1] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019[J]. CA Cancer J Clin,2019,69(1):7-34.
[2] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin,2016,66(2):115-132.
[3] Shirvani SM, Juloori A, Allen PK, et al. Comparison of 2common radiation therapy techniques for definitive treatment of small cell lung cancer[J]. Int J Radiat Oncol Biol Phys,2013,87(1):139-147.
[4] Lin SH, Wang L, Myles B, et al. Propensity score-based comparison of long-term outcomes with 3-dimensional conformal radiotherapy vs intensity-modulated radiotherapy for esophageal cancer[J]. Int J Radiat Oncol Biol Phys,2012,84(5):1078-1085.
[5] Vogelius IR, Bentzen SM. A literature-based metaanalysis of clinical risk factors for development of radiation induced pneumonitis[J]. Acta Oncol,2012,51(8):975-983.
[6] He J, Zeng ZC, Shi SM, et al. Clinical features, outcomes and treatment-related pneumonitis in elderly patients with esophageal carcinoma[J]. World J Gastroenterol,2014,20(36):13185-13190.
[7] Kishida Y, Tsushima T, Endo M, et al. Risk Analysis of Pneumonitis in Taxane Therapy After Chemoradiotherapy for Patients With Metastatic or Recurrent Esophageal Cancer[J]. Am J Clin Oncol,2018,41(1):41-45.
[8] Shaikh T, Churilla TM, Monpara P, et al. Risk of radiation pneumonitis in patients receiving taxane-based trimodality therapy for locally advanced esophageal cancer[J]. Pract Radiat Oncol,2016,6(6):388-394.
[9] Zhao JK, Wu M, Kim CH, et al. Jiangsu Four Cancers Study:a large case-control study of lung, liver, stomach,and esophageal cancers in Jiangsu Province, China[J].Eur J Cancer Prev,2017,26(4):357-364.
[10] Kazerooni EA, Martinez FJ, Flint A, et al. Thin-section CT obtained at 10-mm increments versus limited three-level thin-section CT for idiopathic pulmonary fibrosis:correlation with pathologic scoring[J]. AJR Am J Roentgenol,1997,169(4):977-983.
[11] Satoh K, Kobayashi T, Misao T, et al. CT assessment of subtypes of pulmonary emphysema in smokers[J]. Chest,2001,120(3):725-729.
[12] Asakura H, Hashimoto T, Zenda S, et al. Analysis of dose-volume histogram parameters for radiation pneumonitis after definitive concurrent chemoradiotherapy for esophageal cancer[J]. Radiother Oncol,2010,95(2):240-244.
[13] Nomura M, Kodaira T, Furutani K, et al. Predictive factors for radiation pneumonitis in oesophageal cancer patients treated with chemoradiotherapy without prophylactic nodal irradiation[J]. Br J Radiol,2012,85(1014):813-818.
[14] Zhao Y, Chen L, Zhang S, et al. Predictive factors for acute radiation pneumonitis in postoperative intensity modulated radiation therapy and volumetric modulated arc therapy of esophageal cancer[J]. Thorac Cancer,2015,6(1):49-57.
[15] Cunliffe A, Armato SG 3rd, Castillo R, et al. Lung texture in serial thoracic computed tomography scans:correlation of radiomics-based features with radiation therapy dose and radiation pneumonitis development[J]. Int J Radiat Oncol Biol Phys,2015,91(5):1048-1056.
[16] Chen J, Hong J, Zou X, et al. Association between absolute volumes of lung spared from low-dose irradiation and radiation-induced lung injury after intensitymodulated radiotherapy in lung cancer:a retrospective analysis[J]. J Radiat Res,2015,56(6):883-888.
[17]张丽,汪志,崔珍珍,等.简化适形调强技术与调强适形放疗在胸段食管癌放疗中的剂量学比较[J].安徽医学,2018,39(9):1048-1051.
[2] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin,2016,66(2):115-132.
[3] Shirvani SM, Juloori A, Allen PK, et al. Comparison of 2common radiation therapy techniques for definitive treatment of small cell lung cancer[J]. Int J Radiat Oncol Biol Phys,2013,87(1):139-147.
[4] Lin SH, Wang L, Myles B, et al. Propensity score-based comparison of long-term outcomes with 3-dimensional conformal radiotherapy vs intensity-modulated radiotherapy for esophageal cancer[J]. Int J Radiat Oncol Biol Phys,2012,84(5):1078-1085.
[5] Vogelius IR, Bentzen SM. A literature-based metaanalysis of clinical risk factors for development of radiation induced pneumonitis[J]. Acta Oncol,2012,51(8):975-983.
[6] He J, Zeng ZC, Shi SM, et al. Clinical features, outcomes and treatment-related pneumonitis in elderly patients with esophageal carcinoma[J]. World J Gastroenterol,2014,20(36):13185-13190.
[7] Kishida Y, Tsushima T, Endo M, et al. Risk Analysis of Pneumonitis in Taxane Therapy After Chemoradiotherapy for Patients With Metastatic or Recurrent Esophageal Cancer[J]. Am J Clin Oncol,2018,41(1):41-45.
[8] Shaikh T, Churilla TM, Monpara P, et al. Risk of radiation pneumonitis in patients receiving taxane-based trimodality therapy for locally advanced esophageal cancer[J]. Pract Radiat Oncol,2016,6(6):388-394.
[9] Zhao JK, Wu M, Kim CH, et al. Jiangsu Four Cancers Study:a large case-control study of lung, liver, stomach,and esophageal cancers in Jiangsu Province, China[J].Eur J Cancer Prev,2017,26(4):357-364.
[10] Kazerooni EA, Martinez FJ, Flint A, et al. Thin-section CT obtained at 10-mm increments versus limited three-level thin-section CT for idiopathic pulmonary fibrosis:correlation with pathologic scoring[J]. AJR Am J Roentgenol,1997,169(4):977-983.
[11] Satoh K, Kobayashi T, Misao T, et al. CT assessment of subtypes of pulmonary emphysema in smokers[J]. Chest,2001,120(3):725-729.
[12] Asakura H, Hashimoto T, Zenda S, et al. Analysis of dose-volume histogram parameters for radiation pneumonitis after definitive concurrent chemoradiotherapy for esophageal cancer[J]. Radiother Oncol,2010,95(2):240-244.
[13] Nomura M, Kodaira T, Furutani K, et al. Predictive factors for radiation pneumonitis in oesophageal cancer patients treated with chemoradiotherapy without prophylactic nodal irradiation[J]. Br J Radiol,2012,85(1014):813-818.
[14] Zhao Y, Chen L, Zhang S, et al. Predictive factors for acute radiation pneumonitis in postoperative intensity modulated radiation therapy and volumetric modulated arc therapy of esophageal cancer[J]. Thorac Cancer,2015,6(1):49-57.
[15] Cunliffe A, Armato SG 3rd, Castillo R, et al. Lung texture in serial thoracic computed tomography scans:correlation of radiomics-based features with radiation therapy dose and radiation pneumonitis development[J]. Int J Radiat Oncol Biol Phys,2015,91(5):1048-1056.
[16] Chen J, Hong J, Zou X, et al. Association between absolute volumes of lung spared from low-dose irradiation and radiation-induced lung injury after intensitymodulated radiotherapy in lung cancer:a retrospective analysis[J]. J Radiat Res,2015,56(6):883-888.
[17]张丽,汪志,崔珍珍,等.简化适形调强技术与调强适形放疗在胸段食管癌放疗中的剂量学比较[J].安徽医学,2018,39(9):1048-1051.