Objective:To investigate the effects of clinical characteristics, irradiation techniques and dose-volume parameters on radiation pneumonitis(RP) in thoracic segment esophageal cancer patients, so as to provide reference for the formulation of radiotherapy protocol for thoracic esophageal cancer.Methods:The incidence of RP in 247 patients with thoracic segment esophageal cancer from June 2014 to June 2019 was analyzed retrospectively, then univariate and multivariate analyses were performed on the clinical characteristics, radiation techniques and lung dosimetry parameters of these patients. The area under receiver operating characteristic (ROC) curve was used to verify the diagnostic efficacy of RP≥grade 1, ≥grade 2 and ≥grade 3.Results:There were 118 cases (47.8%)with RP≥grade 1, 54 cases (21.9%)with RP≥grade 2, 17 cases (6.9%)with RP≥grade 3. The result of univariate analysis showed that lung V5- V40 and MLD were both related to the occurrence of RP≥grade 1( Z=-5.802 to -4.306, P<0.05). ≥grade 2, and≥grade 3, respectively( F=0.057 to 11.616、0.087 to 3.392, P<0.05). GTV volume, PTV volume, GTV/lung volume(%) and PTV/lung volume(%) were related to RP≥grade 1( Z=-3.377 to -2.041, P<0.05)and RP≥grade 2( F=3.600 to 9.801, P<0.05). Smoking index >400 was significantly correlated with RP≥grade 3( χ2=13.295, P<0.05), and chronic obstructive pulmonary disease (COPD) was significantly correlated with RP≥grade 1( χ2=9.146, P<0.05). However, there was no significant correlation between RP and different irradiation techniques, chemotherapy factors, radiotherapy dose, esophageal cancer stage and cancer location.The result of multivariate analysis showed that V5 and V40 were independent risk factors of RP≥grade 1(AUC 55.74%、4.13%)、MLD was independent risk factors of RP≥grade 2 (AUC 11.91 Gy), and V5 was independent risk factors of RP≥grade 3(AUC 57.60%). The smoking index>400 was the independent risk factor of RP≥grade 3 ( Wald=5.964, P<0.05), and COPD was the independent risk factor of RP≥1 grade ( Wald=6.110, P<0.05). Conclusions:The incidence of RP is low after radiotherapy for thoracic segment esophageal cancer. The dosimetric parameters such as lung V5, V40, MLD, smoking degree, COPD and other clinical characteristics are closely related to the occurrence of RP of corresponding grades.

目的 回顾性研究单纯手术与术后放疗对食管鳞状细胞癌(Esophageal squamous cell carcinoma,ESCC)的临床疗效及预后影响因素.方法 该院收治的2006年1月-2013年6月接受Ivor-Lewis根治术的Ⅱb～Ⅲc期ESCC患者202名,其中单纯手术者81例,术后放疗者121例,比较两组的生存时间、生存率、复发率等因素.结果 单纯手术组的中位生存时间为31个月,术后放疗组为36个月;单纯手术组的1、3、5年的生存率为80％、31％、16％,术后放疗组为78％、42％、27％,总生存率差异无统计学意义(χ2=2.41,P=0.12>0.05),单纯手术组的1、3、5年的转移率是51％、68％、81％,复发率是52％,术后放疗组的转移率是49％、60％、72％,复发率是33％,差异有统计学意义(χ2=4.49、5.41,P=0.03、0.02).结论 未发现单纯手术和术后放疗对ESCC的总生存率影响的差异,但术后放疗能提高Ⅱb～Ⅲc期ESCC患者的5年生存率.