256例局部晚期NSCLC患者IMRT后急性症状性食管炎预测因素分析

目的 探索局部晚期NSCLC患者IMRT后急性症状性食管炎的发生率及相关预测因素。方法 2007—2011年间在本院治疗的256例未手术的Ⅲ期NSCLC患者。放疗靶区包括原发肺肿瘤及受累淋巴引流区, 中位剂量为60 Gy分30次(50~70 Gy)。109例(42.6%)接受同期化疗。放疗期间及放疗结束后3个月内出现≥2级急性食管炎(症状性食管炎)作为终点事件, 采用CTCAE3.0评估急性食管炎级别。采用Logistic回归模型对预测因素进行分析。结果 174例患者(68%)出现治疗相关的≥2级急性食管炎, 其中154例(60.2%)为2级、20例(7.8%)为3级。≥2级急性食管炎发生时的中位剂量为30 Gy (11~68 Gy)。食管V₅—V₆₀、食管平均剂量及年龄是≥2级急性食管炎的预测因素(P=0.021、0、0.010), 其中高龄是保护性因素;食管V₅₀—V₆₀、同期化疗、体重指数是≥3级急性食管炎的预测因素(P=0.010、0.003、0.019), 其中高体重指数是保护性因素。结论 局部晚期NSCLC患者IMRT后食管V₅₀—V₆₀和同期化疗是≥3级急性食管炎的预测因素, 食管V₅₀对预测≥2级、≥3级急性食管炎都有较高价值。

Predictive factors for acute symptomatic esophagitis in 256 patients with locally advanced non-small cell lung cancer treated with intensity-modulated radiation therapy

Objective To explore the incidence and related predictive factors for acute symptomatic esophagitis in patients with locally advanced non-small cell lung cancer (NSCLC) treated with intensity-modulated radiation therapy (IMRT). Methods Data were collected retrospectively from 256 patients with inoperable or unresectable stage Ⅲ NSCLC treated in our hospital between January 2007 and December 2011.The radiotherapy target volume included primary lung cancer and lymphatic drainage area involved, with a median dose of 60 Gy in 30 fractions (50－70 Gy).Of all the patients, 109 patients (42.6%) received concurrent chemotherapy. Grade ≥2 acute esophagitis (AE)(symptomatic esophagitis) which occurred during radiotherapy and within 3 months after completion of radiotherapy served as the outcome event. National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0(NCI-CTCAE3.0) was used to evaluate the grade of AE.The logistic regression model was used to analyze the predictive factors. Results A total of 174 patients (68%) had treatment-related grade ≥2 AE;154 patients (60.2%) had grade 2 AE and 20 patients (7.8%) had grade 3 AE.The median dose when grade ≥2 AE occurred was 30 Gy (11-68 Gy).For grade ≥2 AE, multivariate analysis showed that esophageal V₅-V₆₀, mean dose, and age were independent predictive factors (P=0.021, 0, 0.010).For grade ≥3 AE, multivariate analysis showed that esophageal V₅₀-V₆₀, concurrent chemotherapy, and body mass index (BMI) were independentpredictivefactors (P=0.010, 0.003, 0.019).Old age and higher BMI were the protective factors for grade ≥2 and≥3 AE, respectively. Conclusions For patients with locally advanced NSCLC treated with IMRT, esophageal V₅₀—V₆₀ and concurrent chemotherapy are predictive factors for grade ≥3 AE, and esophageal V₅₀ has a high predictive value for both grade ≥2 and ≥3 AE.