胰腺癌螺旋断层调强放疗高剂量少分次模式的胃肠毒副反应相关因素分析

doi:10.11904/j.issn.1002-3070.2015.06.001

实用肿瘤学杂志 ›› 2015, Vol. 29 ›› Issue (6): 481-486.doi: 10.11904/j.issn.1002-3070.2015.06.001

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胰腺癌螺旋断层调强放疗高剂量少分次模式的胃肠毒副反应相关因素分析

刘纤¹, 任刚², 李莉琴², 朱夫海², 夏廷毅²

1.安徽医科大学空军临床学院肿瘤放疗科(北京 100142);
2.中国人民解放军空军总医院肿瘤放疗科

收稿日期:2015-07-27 出版日期:2015-12-28 发布日期:2015-12-28
通讯作者: 夏廷毅,E-mail:xiatingyi1959@sina.com E-mail:xiatingyi1959@sina.com
作者简介:刘纤,女,(1991-),硕士研究生,从事临床肿瘤放疗的研究
基金资助:
首都卫生发展科研专项项目(2014-1-5124);空军总医院面上课题(KZ2014037)

Analysis of relative factors on gastrointestinal toxicity with TOMO hypofractioned radiotherapy for pancreatic adenocarcinoma

LIU Xian¹, REN Gang², LI Liqin², ZHU Fuhai², XIA Tingyi²

1.Department of Radiation Oncology,Clinical College of Air Force,Anhui Medical University,Beijing 100142,China;
2.Department of Radiation Oncology,Air Force General Hospital

Received:2015-07-27 Online:2015-12-28 Published:2015-12-28

摘要/Abstract

摘要： 目的探讨采用螺旋断层调强放疗治疗胰腺癌的胃肠毒副反应与剂量学的相关性。方法将2014年1月—2015年1月接受螺旋断层调强放射治疗放疗的68例胰腺癌患者的资料进行分析。分析临床因素、胃及十二指肠剂量体积与放射性毒副反应分级的关系。结果中位随访时间为9个月(4~16个月)。发生2级急性毒性反应18例,3级1例;发生2级晚期毒性反应17例,3级1例。单因素分析中,十二指肠的体积、Dmean、D1、D3、D5、D10、V5、V10、V15、V20、V25、V30、V35、V40、V5′、V10′、V15′、V20′、V25′、V30′、V35′、V40′、V45′与≥2级毒性反应的发生有相关性(P＜0.05)。Logistic多因素回归分析显示,十二指肠V45′是≥2级放射性胃肠毒性反应的独立影响因素(P＜0.05)。V45′的ROC分界值为0.5cm³。结论十二指肠V45′是高剂量少分次放疗胃肠毒副反应发生的重要影响因素。

关键词: 胰腺癌, 胃十二指肠毒性反应, 螺旋断层调强放射治疗, 高剂量少分次模式

Abstract: Objective To identify dosimetric predictors for the development of gastrointestinal toxicity in patients with pancreatic adenocarcinoma treated with TOMO radiotherapy.Methods From January 2014 to January 2015,we analysed the medical records of 68 pancreatic cancer patients who received helical tomotherapy from Air Force General Hospital.The stomach and duodenum were contoured separately to determine their dose volume histogram(DVH)parameters.Chi-square test was employed to analyze the count data.Spearman correlation analysis was used to analyze the relationship between occurrence of gastrointestinal toxicity and clinical and physical factors.Logistic regression models was performed to identify risk factors associated with gastrointestinal toxicity.Results The median follow-up was 9 months(4~16months).18 patients experienced grade II acute gastrointestinal toxicity,1 patient experienced grade Ⅲ acute gastrointestinal toxicity,whereas 17 patients experienced grade II late gastrointestinal toxicity,1 patient experienced grade Ⅲ late gastrointestinal toxicity.On UVA,the volume,Dmean,D1,D3,D5,D10,V5 to V40,and V5′ to V45′ of duodenum were significantly associated with Grade Ⅱ or higher gastrointestinal toxicity(P＜0.05).The MVA,V45′ of duodenum was independent predictor for grade Ⅱ or higher gastrointestinal toxicity(P＜0.05).The ROC analysis also showed that V45′ of 0.5cm3 was the optimal threshold to predict for gastrointestinal toxicity for the entire cohort.Conclusion V45′ of duodenum is of greater importance in the judgment of occurrence of hypofractioned radiation-induced gastrointestinal toxicity.

Key words: Pancreatic cancer, Gastrointestinal toxicity, Helical tomotherapy, Hypofractioned radiation

中图分类号:

R735.9

刘纤, 任刚, 李莉琴, 朱夫海, 夏廷毅. 胰腺癌螺旋断层调强放疗高剂量少分次模式的胃肠毒副反应相关因素分析[J]. 实用肿瘤学杂志, 2015, 29(6): 481-486.

LIU Xian, REN Gang, LI Liqin, ZHU Fuhai, XIA Tingyi. Analysis of relative factors on gastrointestinal toxicity with TOMO hypofractioned radiotherapy for pancreatic adenocarcinoma[J]. PRACTICAL ONCOLOGY JOURNAL, 2015, 29(6): 481-486.

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胰腺癌螺旋断层调强放疗高剂量少分次模式的胃肠毒副反应相关因素分析

Analysis of relative factors on gastrointestinal toxicity with TOMO hypofractioned radiotherapy for pancreatic adenocarcinoma

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