Clinical observation on the efficacy and safety of intensity-modulated radiotherapy for esophageal cancer

HOU Peng; ZHU Xiaojuan; HAN Yalong

doi:10.3969/j.issn.1009-0460.2025.12.009

Abstract：Objective To analyze the efficacy of intensity-modulated radiotherapy(IMRT)in patients with esophageal cancer and the risk factors of acute radiation-induced lung injury(ARILI),and to construct the relevant regression model.Methods The clinical medical records of 312 esophageal cancer patients who underwent IMRT and were admitted to the first affiliated hospital of Henan university of science and technology from January 2021 to June 2024 were collected as the research objects.They were divided into the occurrence group(53 cases,RTOG grades 1-4)and the non-occurrence group(259 cases)based on whether ARILI occurred during the 6-month follow-up after radiotherapy.RTOG grade 0.The therapeutic effects and the occurrence of adverse reactions of the two groups of patients were analyzed.Univariate and multivariate Logistic regression analyses were used to analyze the factors influencing the occurrence of ARILI in patients with esophageal cancer undergoing IMRT,and a model was constructed.Results Among the 312 patients after IMRT,245 cases(78.53%)achieved complete remission,61 cases(19.55%)achieved partial remission,6 cases(1.92%)had no remission,and the total remission rate was 98.08%.There were 29 cases(9.29%)of radiation esophagitis,53 cases(16.99%)of ARILI,31 cases(9.94%)of bone marrow suppression,and 15 cases(4.81%)of gastrointestinal reactions.Compared with the group without ARILI,the proportion of patients with a total radiotherapy dose of≥60 Gy and lymph node metastasis was higher in the group with ARILI,and the levels of lung V5,lung V10,lung V20,lung V30,average lung dose(MLD),serum interleukin(IL)-8,and transforming growth factor-β1(TGF-β1)were all higher(P<0.05).The results of multivariate Logistic regression analysis showed that Lung V5>50%,lung V20>25%,lung V30>20%,elevated serum IL-8 level,and elevated serum TGF-β1 level are all risk factors for ARILI in patients with esophageal cancer after IMRT(OR=1.608,2.523,2.087,1.020,1.014,P<0.05).Based on this,a regression equation was constructed:logit(P)=-109.606+lung V5×0.475+lung V20×0.925+lung V30×0.736+serum IL-8 level×0.019+serum TGF-β1 level×0.014.The results of the receiver operating characteristic curve(ROC)showed that when Logit(P)>0.20,the area under the curve(AUC)value was 0.999,the 95%CI was 0.997 to 1.000,the sensitivity was 100.00%,and the specificity was 98.84%.Conclusion The effect of IMRT in patients with esophageal cancer is good,but the safety is average.The risk factors for ARILI in patients with esophageal cancer undergoing IMRT are lung V5>50%,lung V20>25%,lung V30>20%,high serum IL-8 level,and high serum TGF-β1 level.The model established in this way can take targeted treatment and intervention measures for patients who meet the above characteristics,helping to improve the prognosis of patients.