2018 年第 1 期 第 13 卷

中下段食管鳞癌患者行三维适形调强放射疗法与发生放射性肺损伤的相关性

作者：孟令新韩菁周丹丹王传艳厉兵城孟芹吴海英

英文作者：

单位：276826山东省日照市人民医院肿瘤科(孟令新、周丹丹、王传艳、厉兵城、孟芹、吴海英),放疗科（韩菁）

英文单位：

关键词：食管肿瘤；调强放疗；肺损伤

英文关键词：

• 摘要：

• 【摘要】目的    分析中下段食管鳞癌患者行三维适形调强放射疗法(IMRT)与发生放射性肺损伤的相关性。方法    选择2011年5月至2014年5月在山东省日照市人民医院行IMRT治疗的中下段食管鳞癌患者72例。采用瓦里安直线加速器Ix-6074、Eclipse 11计划系统进行IMRT，处方剂量（60～68）Gy/（30～34）F，在95%计划靶区达到处方剂量。分析中下段食管鳞癌患者行IMRT后发生放射性肺损伤与各临床资料的相关性，IMRT治疗疗效，IMRT的物理参数与发生放射性肺损伤的相关性。结果    72例患者中发生1～2级放射性肺损伤者9例(12.5%)，均未出现2级以上放射性肺损伤。中下段食管癌患者肿瘤病变长度、慢性阻塞性肺疾病及放疗总量与IMRT后发生放射性肺损伤相关（P=0.002、0.018、0.031）。放疗结束后1年，根据食管造影X线片，完全缓解28例（38.9%），部分缓解40例（55.7%），疾病稳定4例（5.7%），1年总生存率达94.4%（68/72）。根据是否发生放射性肺损伤，将72例患者分为无放射性肺损伤组（63例）和放射性肺损伤组（9例）。放射性肺损伤组肺V10、V15、V20、V30、Dmean水平高于无放射性肺损伤组［(4 327±447) mm2比(3 716±1 126) mm2、(2 934±523) mm2比(2 486±504) mm2、(2 458±579) mm2比(1 636±534) mm2、(1 002±463) mm2比(733±325) mm2、(1 068±216) mm2比(927±325) mm2］，差异均有统计学意义（均P＜0.05），而放射性肺损伤组肺V5、V25、V35、V40、Dmax和Dmin与无放射性肺损伤组比较，差异均无统计学意义（均P＞0.05）。结论    肺V10、V15、V20、V30、Dmean剂量是放射性肺损伤关键因素，食管鳞癌IMRT中放射剂量学因素可较好预测放射性肺损伤的发生。    

• Correlation between three-dimensional conformal intensity-modulated radiotherapy and radiation-induced lung injury in patients with squamous cell carcinoma of middle and lower esophagus

  Meng Lingxin, Han Jing, Zhou Dandan, Wang Chuanyan, Li Bingcheng, Meng Qin, Wu Haiying

  Department of Oncology, People′s Hospital of Rizhao, Shandong Province, Rizhao 276826, China(Meng LX, Zhou DD, Wang CY, Li BC, Meng Q, Wu HY); Department of Radiotherapy, People′s Hospital of Rizhao, Shandong Province, Rizhao 276826, China(Han J)

  Corresponding author: Meng Lingxin, Email: menglx001623@163.com

  【Abstract】Objective     To analyze the correlation between three-dimensional conformal intensity-modulated radiotherapy(IMRT) and radiation-induced lung injury in patients with squamous cell carcinoma of lower middle esophagus. Methods    Seventy-two patients with squamous cell carcinoma of middle and lower esophagus who had IMRT from May 2011 to May 2014 in People′s Hospital of Rizhao were enrolled. Varian Ix-6074 linear accelerator and Eclipse 11 system were used in IMRT, with prescription dose （60-68）Gy/（30-34）F in 95% planning target volume. Correlations among occurrence of radiation-induced lung injury, related clinical data and physical parameters of IMRT were analyzed. Results    Grade 1-2 radiation-induced lung injury occurred in 9 cases(12.5%). Length of esophageal lesion, chronic obstructive pulmonary disease and total amount of radiotherapy were related to the occurrence of lung injury(P=0.002, 0.018, 0.031). Esophagography 1 year after radiotherapy showed 28 cases(38.9%) of complete remission, 40 cases(55.7%) of partial remission and 4 cases(5.7%) of stable disease; the 1-year total survival rate was 94.4%(68/72). All patients were divided into non-radiation-induced lung injury group(63 cases) and radiation-induced lung injury group(9 cases). Lung V10, V15, V20, V30 and Dmean in radiation-induced lung injury group were significantly higher than those in non-radiation-induced lung injury group［(4 327±447)mm2 vs (3 716±1 126)mm2, (2 934±523)mm2 vs (2 486±504)mm2, (2 458±579)mm2 vs (1 636±534)mm2, (1 002±463)mm2 vs (733±325)mm2, (1 068±216)mm2 vs (927±325)mm2］(P＜0.05). There were no significant differences of lung V5, V25, V35, V40, Dmax and Dmin between groups(P＞0.05). Conclusion    Lung V10, V15, V20, V30 and Dmean are key factors of radiation-induced lung injury in IMRT for squamous cell carcinoma of middle and lower esophagus.

  【Key words】Esophageal neoplasms;Intensity-modulated radiotherapy;Lung injury

  【Fund program】Medical Science and Technology Development Project of Shandong Province(2016WS0329); Research Support Fund for Young Teachers of Jining Medical University(JY2016KJ050Y)