华西医学

华西医学

未手术食管癌患者放射治疗后放射性肺损伤影响因素的研究

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目的从临床资料和物理学参数方面对未手术食管癌患者放射治疗(放疗)后发生放射性肺损伤的相关影响因素予以分析,以指导临床放疗计划有效设计、安全执行。 方法收集2010年10月-2012年11月采用调强放疗、未行手术治疗的食管鳞癌患者59例,应用统计学方法研究患者临床特征及物理学参数指标与急性放射性肺损伤的相关关系。 结果入组患者中,33例(55.9%)放疗后出现急性放射性肺损伤,其中9例(15.3%)发生3级以上急性放射性肺损伤。放疗期间合并有肺部感染、平均肺剂量(MLD)等剂量学参数与急性放射性肺损伤发生显著相关(P<0.05)。尤其是放疗期间合并肺部感染、放疗计划设计中MLD≥13 Gy、V30≥13%时,放射性肺损伤发生率明显增加。 结论放疗期间合并肺部感染、MLD、V30是放射性肺损伤发生的影响因素,在制定放疗计划中要充分考虑,避免放射性肺损伤发生。

ObjectiveTo analyze the clinical and dosimetric impacts on radiation pneumonitis (RP), and provides data for radiotherapy planning. MethodsWe reviewed 59 non-operative esophageal cancer patients who underwent radiotherapy from October 2010 to November 2012 to identify the correlation between the clinical and dosimetric parameters with acute radiation pneumonitis (ARP) and severe acute radiation pneumonitis (SARP) by t-Test, Chi-Square Test and logistic regression analysis. ResultsAmong the 59 patients, 33 (55.9%) developed ARP, in whom 9 (15.3%) developed SARP. Univariate analysis showed that lung infection during radiotherapy, mean lung dose (MLD), and dosimetric parameters are significantly correlated with RP. Multivariate analysis revealed lung infection during radiotherapy, MLD≥13 Gy, and V30≥13% were significantly correlated with the increasing risk RP. ConclusionLung infection during radiotherapy, MLD, and V30 are the influencing factors of RP, which should be seriously considered when formulating radiotherapy plan to avoid RP.

关键词: 急性放射性肺损伤; 食管癌放射治疗; 影响因素

Key words: Acute radiation pneumonitis; Radiotherapy for esophageal cancer; Influencing factors

引用本文: 赵娅琴, 荣丽雯, 冯旭琴, 朱洪, 张英杰, 李志平. 未手术食管癌患者放射治疗后放射性肺损伤影响因素的研究. 华西医学, 2014, 29(11): 2036-2041. doi: 10.7507/1002-0179.20140616 复制

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