摘要目的：探索局部晚期NSCLC患者IMRT后急性症状性食管炎的发生率及相关预测因素。方法2007—2011年间在本院治疗的256例未手术的Ⅲ期NSCLC患者。放疗靶区包括原发肺肿瘤及受累淋巴引流区，中位剂量为60 Gy分30次（50～70 Gy）。109例（42．6％）接受同期化疗。放疗期间及放疗结束后3个月内出现≥2级急性食管炎（症状性食管炎）作为终点事件，采用CTCAE3．0评估急性食管炎级别。采用Logistic回归模型对预测因素进行分析。结果174例患者（68％）出现治疗相关的≥2级急性食管炎，其中154例（60．2％）为2级、20例（7．8％）为3级。≥2级急性食管炎发生时的中位剂量为30 Gy （11～68 Gy）。食管V5—V60、食管平均剂量及年龄是≥2级急性食管炎的预测因素（P＝0．021、0、0．010），其中高龄是保护性因素；食管V50—V60、同期化疗、体重指数是≥3级急性食管炎的预测因素（P＝0．010、0．003、0．019），其中高体重指数是保护性因素。结论局部晚期NSCLC患者IMRT后食管V50—V60和同期化疗是≥3级急性食管炎的预测因素，食管V50对预测≥2级、≥3级急性食管炎都有较高价值。

abstractsObjective To explore the incidence and related predictive factors for acute symptomatic esophagitis in patients with locally advanced non?small cell lung cancer ( NSCLC ) treated with intensity?modulated radiation therapy ( IMRT) . Methods Data were collected retrospectively from 256 patients with inoperable or unresectable stage Ⅲ NSCLC treated in our hospital between January 2007 and December 2011. The radiotherapy target volume included primary lung cancer and lymphatic drainage area involved,with a median dose of 60 Gy in 30 fractions (50-70 Gy).Of all the patients,109 patients (42.6%) received concurrent chemotherapy. Grade ≥2 acute esophagitis ( AE ) ( symptomatic esophagitis ) which occurred during radiotherapy and within 3 months after completion of radiotherapy served as the outcome event. National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0( NCI?CTCAE3.0) was used to evaluate the grade of AE. The logistic regression model was used to analyze the predictive factors. Results A total of 174 patients ( 68%) had treatment?related grade ≥2 AE;154 patients ( 60. 2%) had grade 2 AE and 20 patients (7.8%) had grade 3 AE.The median dose when grade≥2 AE occurred was 30 Gy (11?68 Gy).For grade≥2 AE,multivariate analysis showed that esophageal V5?V60,mean dose,and age were independent predictive factors (P=0.021,0,0.010).For grade ≥3 AE,multivariate analysis showed that esophageal V50?V60 ,concurrent chemotherapy,and body mass index ( BMI) were independent predictive factors ( P= 0.010,0.003,0.019 ) . Old age and higher BMI were the protective factors for grade≥2 and ≥3 AE, respectively. Conclusions For patients with locally advanced NSCLC treated with IMRT, esophageal V50—V60 and concurrent chemotherapy are predictive factors for grade ≥3 AE,and esophageal V50 has a high predictive value for both grade ≥2 and ≥3 AE.