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.
引文
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