评估乳腺癌患者进行低照射剂量区域淋巴结放射治疗时放射性食管炎（RE）的发病率和剂量体积预测因子。符合条件的患者包括在乳房切除术后在胸壁、上颈锁/下颈锁窝、II级腋窝和/或乳内链进行调强放射治疗（RT）的患者。处方剂量为43.5 Gy / 15次。 RE每周进行评估，并在RT后1和2周，以及在RT后3和6个月进行评估，根据不良事件常见毒性标准v3.0进行分级。 食管从环状软骨的下缘到主动脉弓下缘进行轮廓划分。评估食管总体积，平均剂量（Dmean），最大剂量（Dmax）以及相对和绝对体积以5 Gy的增量至少接受5-45 Gy（RV5-RV45和AV5-AV45）。执行单变量和多元逻辑回归分析以确定RE的风险因素，并获得接收者操作特征曲线以确定食管剂量参数的阈值。总共包括298名患者，时间为2020年5月8日至2022年1月5日（RT后最短随访时间为6个月）。 2级和3级RE发生率分别为40.9％（122/298）和0.3％（1/298）。没有观察到4或5级RE。 食管RV10-RV40和AV35-AV40与肿瘤侧向和乳内淋巴结放射治疗调整后≥2级RE的风险显着相关。 RV25和AV35是≥2级RE的最佳剂量体积预测因子，其阈值分别为RV25的20％（35.9％与60.9％，p = .04）和AV35的0.27 mL（31.0％与54.6％，p = .04）。在接受低照射剂量区域淋巴结放射治疗的乳腺癌患者中，RE很常见。保持上食管V25低于20％和V35低于0.27 mL可能会降低RE的风险。版权所有©2023年。Elsevier Inc.出版

To assess the incidence and dose-volume predictors of radiation esophagitis (RE) in breast cancer patients undergoing hypofractionated regional nodal irradiation (RNI).Eligible patients were included who received intensity-modulated radiotherapy (RT) at the chest wall, the supraclavicular/infraclavicular fossa, level II axilla, and/or the internal mammary chain after mastectomy. The prescribed dose was 43.5 Gy in 15 fractions. RE was evaluated weekly during RT and at 1 and 2 weeks, followed by 3 and 6 months after RT, and was graded according to the Common Toxicity Criteria for Adverse Events v3.0. The esophagus was contoured from the lower border level of the cricoid cartilage to the lower margin of the aortic arch. Esophageal total volume, mean dose (Dmean), maximum dose (Dmax), and the relative and absolute volumes receiving at least 5-45 Gy by 5 Gy increments (RV5-RV45 and AV5-AV45) were evaluated. Univariable and multivariable logistics regression analyses were performed to determine risk factors for RE, and receiver operating characteristic curves were obtained to identify the thresholds of esophageal dosimetric parameters.In total, 298 patients were included between May 8, 2020 and January 5, 2022 (minimum post-RT follow-up: 6 months). Grade 2 and 3 RE incidence was 40.9% (122/298) and 0.3% (1/298), respectively. No grade 4 or 5 RE was observed. Esophageal RV10-RV40 and AV35-AV40 were significantly associated with the risk of ≥grade 2 RE after adjusting for tumor laterality and internal mammary nodal irradiation. RV25 and AV35 were optimum dose-volume predictors for ≥grade 2 RE at thresholds 20% for RV25 (35.9% vs. 60.9%, p = .04) and 0.27 mL for AV35 (31.0% vs. 54.6%, p = .04).RE is common in breast cancer patients undergoing hypofractionated RNI. Maintaining the upper esophageal V25 at <20% and V35 at <0.27 mL may decrease the risk of RE.Copyright © 2023. Published by Elsevier Inc.