【摘要】 目的 探讨食管鳞癌患者免疫检查点抑制剂诱导治疗序贯根治性放疗后发生放射性肺炎的危险因素。方法 回顾2020年1月至2021年8月浙江省肿瘤医院接受免疫检查点抑制剂诱导治疗序贯根治性放疗的食管鳞癌患者107例，放射性肺炎的评级按照美国国立癌症研究所常见不良反应术语评定标准5.0版（CTCAE 5.0）进行评价；通过ROC曲线计算双肺剂量学参数V_{5 Gy}、V_{20 Gy}、V_{30 Gy}和平均肺剂量（MLD）的最佳截断值。结果 食管鳞癌患者放疗后发生了2级及以上放射性肺炎23例（21.5%），双肺V_{5 Gy}、V_{20 Gy}、V_{30 Gy}和MLD的最佳截断值分别为45%（AUC=0.756,P<0.01）、17%（AUC=0.731,P<0.01）、8%（AUC=0.728,P<0.01）和9.5 Gy（AUC=0.734,P<0.01）。多因素logistic回归分析显示，诱导治疗周期数和双肺V_{5 Gy}是发生放射性肺炎的独立危险因素（均P<0.05）。结论 免疫检查点抑制剂诱导治疗序贯根治性放疗后放射性肺炎的发生率和根治性放疗的历史数据类似，诱导治疗周期数和双肺V_{5 Gy}能够预测放射性肺炎的发生。更多还原

【Abstract】 Objective To investigate the risk factors of radiation-induced pneumonia（RIP） in patients with esophageal squamous cell carcinoma（ESCC） patients after immune check points inhibitor（ICI） therapy and sequential definitive radiotherapy. Methods One hundred and seven patients with ESCC who received ICI therapy followed by radiotherapy in Zhejiang Cancer Hospital between January 2020 and August 2021,were enrolled in this study. RIP was scored monthly after definitive radiotherapy, using the National Cancer Institute’s Common Terminology Criteria for Adverse Events（CTCAE） version 5.0. The discriminative ability of lung DVH parameters(lung V_{5 Gy}, V_{20 Gy}, V_{30 Gy}and MLD) was determined according to the receiver operating characteristic（ROC） curves. Results Twenty-seven cases（21.5%） patients experienced RIP after radiotherapy. The optimal cutoff values of lung V_{5 Gy}, V_{20 Gy}, V_{30 Gy}and MLD were set at 45%（AUC=0.756, P < 0.01）, 17%（AUC=0.731, P < 0.01）, 8%（AUC=0.728, P < 0.01） and 9.5 Gy（AUC=0.734,P < 0.01）. Multivariate analysis showed that lung V_{5 Gy} and cycle number of immunotherapy were independent risk factors（both P < 0.05）. Conclusion The incidence of RIP is not increased in ESCC patients who received ICI therapy followed by definitive radiotherapy. The cycle number of ICI therapy and lung V_{5 Gy}are independent predictors for occurrence of RIP.更多还原