肺癌同期放化治疗中放射性肺损伤的相关因素分析  

Predictors of Pulmonary Lesion Induced by Three Dimensional Conformal Radiotherapy Combined with Chemotherapy of NP for Ⅲ Stage Non-small Cell Lung Cancer

作　　者：张彬[1] 乔田奎[1] 

机构地区：[1]复旦大学附属金山医院放疗科,上海200540

出　　处：《肿瘤防治研究》2010年第5期578-581,共4页Cancer Research on Prevention and Treatment

摘　　要：目的观察三维适形放疗联合同期化疗治疗局部晚期非小细胞肺癌中放射性肺损伤情况,对其相关因素进行分析,寻找合理的预测性指标。方法 47例符合入组条件的非小细胞肺癌患者接受三维适形放疗及同期化疗。处方剂量为60Gy常规放疗,同期化疗方案为NP方案,对三维适形治疗计划及临床资料进行单因素、多因素分析,评价肺损伤情况。结果 (1)完全缓解3例,部分缓解42例,总有效率为95.74%,1年生存率75.78%。全组发生急性放射性肺炎0级2例,1级20例,2级17例,3级8例,无4级放射性肺炎发生。(2)与严重放射性肺炎发生呈正相关的剂量学因素为MLD、肺NTCP,肺V5、V15、V20。临床资料中仅发现肿瘤GTV与严重放射性肺炎发生相关;多因素分析显示全肺平均剂量为放射性肺炎的独立影响因素。结论剂量学因素(MLD、肺NTCP,肺V5、V15、V20)可以较好地预测严重放射性肺炎的发生,全肺平均剂量是放射性肺炎发生的独立影响因素。Objective To observe the toxicity in the lung by three dimensional conformal radiotherapy（3DCRT）combined with concurrent chemotherapy for Ⅲ stage non-small cell lung cancer（NSCLC）.Methods From Sep.2006 to Jul.2008,47 patients with NSCLC were treated with 3DCRT combined with concurrent chemotherapy of navelbine＋cisplatin（NP）.The patients received conventional fractionated radiation.The prescription dose is 60 Gy.Univariate and multivariate analysis were performed to test the association between radiation pneumonitis（RP）and dosimetric and clinical factors.Results（1）Three patients showed complete remission（CR）,forty-two patients partial remission（PR）with an overall response rate of 95.74% and the 1-year survival of 75.78%.Of these 47 patients,45 developed radiation pneumonitis（RP）：20 grade 1,17 grade 2 and 8 grade 3,there was no radiation pneumonitis of grade 4.（2）The correlative dosimetric factors included;mean lung dose（MLD）,normal tissue complication probability（NTCP）and volume of lung which received≥5,15 and 20 Gy.Of the clinical factors,the volume of gross tumor volume（GTV）was associated with RP.Only mean lung dose was independently associated with RP according to the multivariate analysis.Conclusion Dosimetric factors（MLD,NTCP,lungV5,V15,V20）were pronounced predictors of radiation pneumonitis（RP）after 3DCRT combined with concurrent chemotherapy of navelbine＋cisplatin（NP）for Ⅲ stage NSCLC.According to the multivariate analysis,mean lung dose（MLD）was independently associated with RP.

关 键 词：非小细胞肺癌 三维适形放射治疗 化学疗法 放射性肺炎 

分 类 号：R734.2[医药卫生—肿瘤]