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目的 :应用随机效应模型分析非小细胞肺癌同期放化疗中的急性放射性食管炎发生率与食管受到的照射剂量和容积关系。方法 :6 2例不能手术的Ⅱ期和Ⅲ期非小细胞肺癌患者于 1998年 3月至 2 0 0 0年 11月间在M .D .Anderson癌症治疗中心进入随机、临床Ⅲ期的同期放化疗治疗研究 ,比较应用或未用阿米福汀 (amifostine)时对食管毒性反应的作用。对其中 39例有三维治疗计划的病例进行回顾性分析 ,阿米福汀组和非阿米福汀组分别为 19和 2 0例。急性食管炎程度的评估为每周 1次 ,在放疗结束后的 1个月再随访评估 1次。评分的标准根据RTOG急性反应的标准。放疗的方式为 1.2Gy/次 ,2次 /d ,前后野对照治疗至 4 0～ 5 0Gy后采用避开脊髓的斜野放疗 ,至总剂量 6 9.6Gy/ 6周。所有的患者在放疗前均接受顺铂和口服依托泊苷 (VP 16 )的化疗。采用多因素的随机效应模型分析急性食管炎的评分 (严重程度 )与不同的剂量容积因素的关系。结果 :39例中 ,阿米福汀组中 2例(11% ) ,非阿米福汀组 6例 (30 % )患者发生了Ⅲ度的急性食管炎。Ⅲ度急性食管炎最早出现在治疗的第 3周末 ,即累计肿瘤量达 36Gy时。第 4周后 ,呈一平缓的趋势 ,其发生率并不随以后剂量的增加而明显提高。在所有与Ⅲ度食管炎发生有关的剂量和容积因素中 ,以?
Objective: To analyze the relationship between the incidence of acute radiation esophagitis and esophageal radiation dose and volume in concurrent chemoradiotherapy of non-small cell lung cancer using random effects model. METHODS: Sixty-two patients with stage II and III non-small cell lung cancer who were inoperable were enrolled at the M.D. Anderson Cancer Center from March 1998 to November 2000 at the same randomization and clinical phase III Chemotherapy Study to compare the effect of amifostine on esophageal toxicity with or without amifostine. Thirty-nine patients with three-dimensional treatment plan were retrospectively analyzed. There were 19 cases in the amifostine group and 20 cases in the non-amifostine group. The degree of acute esophagitis was assessed once weekly and again at 1 month after the end of radiotherapy. Scoring criteria are based on the criteria of the RTOG acute response. Radiotherapy was performed at 1.2 Gy / sec, 2 times / d, with avertebral field radiation avoidance of spinal cord to 60-6 Gy / 6 weeks before and after field control until 40 to 50 Gy. All patients underwent chemotherapy with cisplatin and oral etoposide (VP 16) before radiotherapy. A multifactorial random effects model was used to analyze the relationship between severity (esophagitis) scores and different dose volume factors. Results: Of 39 patients, Ⅲ degree acute esophagitis occurred in 2 patients (11%) in amifostine group and 6 patients (30%) in non-amifostine group. Ⅲ degree acute esophagitis first appeared in the treatment of the third weekend, that is, when the cumulative tumor volume reached 36Gy. After 4 weeks, there was a gentle trend, the incidence did not increase with the subsequent dose significantly increased. Among all the dose and volume factors associated with the occurrence of grade III esophagitis,