Clinical and dosimetric factors associated with acute radiation-induced pneumonitis in esophageal carcinoma patients after intensity modulated radiation therapy (IMRT)

doi:10.16150/j.1671-2870.2019.01.013

Abstract

Abstract:

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?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.

Key words: Radiation-induced pneumonitis, Esophageal cancer, Intensity modulated radiation therapy, Dosimetric parameter

CLC Number:

R541.7

ZHENG Lei, ZHAO Shengguang, XU Chen, JIANG Xu ming, CAO Lu, WU Hualing, CHEN Jiayi. Clinical and dosimetric factors associated with acute radiation-induced pneumonitis in esophageal carcinoma patients after intensity modulated radiation therapy (IMRT)[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(1): 66-71.

Figures/Tables 6

References 17

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评分	肺纤维化	肺气肿
0	无纤维化改变	肺内无过低密度区（low air areas, LAAs）
1	叶间裂增厚	散在的LAAs，最大径不超过5 mm
2	蜂窝样改变（伴或不伴叶间裂增厚）累及<25%的肺叶	毗邻的LAAs，最大径不超过10 mm
3	蜂窝样改变（伴或不伴叶间裂增厚）累及25%~49%的肺叶	LAAs>10 mm，互相连接成片状
4	蜂窝样改变（伴或不伴叶间裂增厚）累及50%~75%的肺叶	缺乏正常的肺间质结构
5	蜂窝样改变（伴或不伴叶间裂增厚）累及>75%的肺叶	-

分级	判断标准
1度	无症状，仅有影像学改变
2度	有症状，但不干扰日常生活
3度	有症状，影响日常生活，需要氧气治疗
4度	影响生命，需要呼吸机支持
5度	死亡

变量	病例总数	放射性肺炎≥1度的病例总数(%)	χ²值	P值	放射性肺炎≥2度的病例总数(%)	χ²值	P值
性别			1.667	0.2		3.192	0.078
男	74	35(47.3%)			14(18.9%)
女	14	4(28.6%)			0(00.0%)
年龄（岁）			0.040	0.843		0.222	0.639
≤70	73	32(43.8%)			11(15.1%)
>70	15	7(46.7%)			3(20.0%)
食管癌根治术			9.353	0.003		0.076	0.783
是	47	14(29.8%)			7(14.9%)
否	41	25(61.0%)			7(17.1%)
治疗模式			5.888	0.017		0.145	0.705
根治放疗	38	23(60.5%)			6(15.8%)
辅助放疗	31	10(32.3%)			4(12.9%)
姑息放疗	19	6(31.6%)			4(21.1%)
位置			3.658	0.058		0.074	0.786
上段	36	9(25.0%)			4(11.1%)
中段	39	25(64.1%)			9(23.1%)
下段	13	5(38.5%)			1(7.7%)
化疗			0.038	0.846		0.001	0.972
紫杉类为主	31	13 (41.9%)			4(12.9%)
氟尿类为主	38	19(50.0%)			8(21.1%)
无化疗	19	7(36.8%)			2(10.5%)
基线PF评分			2.15	0.146		0.317	0.575
0~2分	57	22(38.6%)			10(17.5%)
3~4分	31	17(54.8%)			4(12.9%)
基线PE评分			0.431	0.513		0.065	0.800
0~1分	53	25(47.2%)			8(15.1%)
2~4分	35	14(40.0%)			6(17.1%)
剂量(Gy)			2.594	0.111		0.213	0.645
≤55	49	18(36.7%)			7(14.3%)
>55	39	21(53.8%)			7(17.9%)

变量	放射性肺炎≥1度			P值	放射性肺炎≥2度		P值
变量	总量(88)	是(39)	否(49)	P值	是(14)	否(74)	P值
TLV(cm³)	3 480±941	3 351±791	3 582±1 042	0.257	3 301±817	35 14±964	0.396
PTV(cm³)	343±156	371±155	322±154	0.145	400±137	332±157	0.117
MLD(Gy)	10.91±2.81	12.42±2.36	9.71±2.56	0.001	12.78±2.78	10.56±2.69	0.013
V5	54.33±16.8	64.16±13.83	46.51±14.8	0.001	65.43±14.06	52.23±16.53	0.005
V10	39.34±13.11	45.77±12.68	34.22±11.13	0.001	49.13±12.69	37.49±12.42	0.005
V20	19.47±5.96	21.66±5.71	17.73±5.63	0.002	23.73±7.38	18.67±5.35	0.027
V30	8.32±3.59	8.94±3.66	7.83±3.5	0.155	8.49±3.86	8.29±3.57	0.861
V40	3.41±2.47	3.77±2.86	3.12±2.09	0.238	3.29±2.70	3.43±2.44	0.857

分级	变量	β	S.E	Wald	P值	Exp(B)	95%CI
放射性肺炎≥1度	V5	0.09	0.022	17.631	0.001	1.095	1.049~1.142
放射性肺炎≥2度	V10	0.068	0.025	7.407	0.006	1.071	1.019~1.125