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目的探究局部晚期非小细胞肺癌调强放疗后毒性反应情况。方法选择2014年8月—2016年9月期间在本院行调强放疗的70例局部晚期非小细胞肺癌患者作为研究对象。本组患者均采用固定野调强放疗技术,单次分割剂量均为2 Gy,5次/周,所有患者均行6~8个周期的治疗,观察患者放疗期间及放疗结束后3个月内不良反应发生情况,依据美国癌症研究所的CTCAE3.0常见毒性分级标准评估患者不良反应情况,采用RTOG分级标准评估患者放射性食管炎或放射性肺损伤,并统计分析发生时间及发生率。计量资料采用t检验,计数资料采用χ~2检验,P<0.05为差异有统计学意义。结果本组患者放疗后放射性食管炎发生率为68.57%,发生时间为放疗5~49 d,中位时间为27 d。2级放射性食管炎占比最高(58.57%),显著高于1级(2.86%)和3级(7.14%)占比,对比差异有统计学意义(P<0.05)。1级放射性食管炎占比(2.86%)显著少于3级(7.14%),对比差异有统计学意义(P<0.05)。放疗后放射性肺损伤发生率为36.62%,发生时间为放疗后10~77 d,中位时间为44 d。2级放射性肺损伤占比最高(21.43%)显著高于1级(14.29%)和3级(8.57%)占比,对比差异有统计学意义(P<0.05)。本组患者中出现白细胞降低(14.29%),血小板降低(16.90%),放射性皮炎(15.71%),三者均低于放射性肺损伤(36.62%)和放射性食管炎(68.57%)发生率,对比差异有统计学意义(P<0.05)。结论局部晚期非小细胞肺癌调强放疗后毒性反应以放射性食管炎和放射性肺损伤为主,应合理调整放疗剂量,及时做好两者监测及防控干预,进而保证调强放疗治疗效果。
Objective To investigate the toxicity of IMRT in locally advanced non-small cell lung cancer. Methods Seventy patients with locally advanced non-small cell lung cancer undergoing intensity modulated radiotherapy from August 2014 to September 2016 were selected as the study subjects. This group of patients were treated with fixed wild-type radiotherapy, single dose divided into 2 Gy, 5 times / week, all patients were treated 6 to 8 cycles, observe the patients during radiotherapy and 3 months after the end of radiotherapy According to the common toxicity classification standard of CTCAE3.0 of American Cancer Institute, adverse reactions were evaluated. RTOG grading criteria were used to evaluate esophagitis or radiation-induced lung injury, and the time and incidence of radiation were statistically analyzed. Measurement data using t test, count data using χ ~ 2 test, P <0.05 for the difference was statistically significant. Results The incidence of radiation esophagitis in this group of patients was 68.57% after radiotherapy. The time for radiotherapy was 5 to 49 days and the median time was 27 days. Grade 2 esophagitis accounted for the highest proportion (58.57%), significantly higher than Grade 1 (2.86%) and Grade 3 (7.14%), with significant difference between the two groups (P <0.05). Grade 1 esophagitis accounted for (2.86%) significantly less than Grade 3 (7.14%), the difference was statistically significant (P <0.05). The incidence of radiation-induced lung injury after radiotherapy was 36.62%. The time of radiotherapy was 10-77 days after radiotherapy. The median time was 44 days. Grade 2 radiation lung injury accounted for the highest proportion (21.43%) than Grade 1 (14.29%) and grade 3 (8.57%), the difference was statistically significant (P <0.05). The incidence of leukopenia (14.29%), thrombocytopenia (16.90%) and radiodermatitis (15.71%) were lower than those of radiation-induced lung injury (36.62%) and radiation esophagitis (68.57%) The difference was statistically significant (P <0.05). Conclusion Toxicity of radiation-induced esophagitis and radiation-induced lung injury in locally advanced non-small cell lung cancer after IMRT should be adjusted appropriately. The monitoring and prevention and intervention should be done in time so as to ensure the therapeutic effect of IMRT.