功能肺DVH参数预测局部晚期非小细胞肺癌放疗诱导的放射性肺损伤  

Prediction of radiation-induced lung toxicity in locally advanced non-small cell lung cancer treated with chemoradiotherapy by functional lung dose-volume histogram

作　　者：王冬青[1] 李宝生[1] 孙洪福[1] 张健[1] 卢洁[2] 刘波[2] 李洪升[1] 马长升[2] 

机构地区：[1]山东省肿瘤医院放疗科,济南250117 [2]山东省肿瘤医院物理室,济南250117

出　　处：《中华放射医学与防护杂志》2011年第3期308-311,共4页Chinese Journal of Radiological Medicine and Protection

基　　金：基金项目：山东省科技攻关计划（2006GG2202012）

摘　　要：目的探讨功能肺剂量体积直方图（LDVH）参数与后程加速超分割放疗诱导的放射性肺损伤（RILT）的相关性，筛选敏感度、特异度、准确性较高的LDVH预测因子及其参考阈值。方法行PET／CT／SPECT融合影像引导胸部精确放疗的Ⅲ期非小细胞肺癌（NSCLC）患者51例，在PhilipsPinnacle。治疗计划系统勾画肿瘤靶区和周围危及器官，制定三维适形或调强放疗计划。采用NCICTC3．0标准对RILT进行分级。分析双侧肺、同侧肺以及功能肺DVH参数与RILT的相关性，筛选预测RILT的最佳参数及其阈值。结果中位随访15个月，有10例（19．6％）发生≥2级RILT。单因素分析双侧肺V5～V40,同侧肺V5-V20，功能肺V5～V50与≥2级RILT发生有关，多因素分析显示双侧肺V15、功能肺V20与RILT相关（P=0．005，0．016）。ROC曲线分析显示功能肺y，。（45．38％）预测敏感度最高，为90％；功能肺％（27．78％）预测特异度最高，为90．24％；功能肺‰（29．61％）预测的敏感度、特异度、准确性分别达到70．00％、73．17％、74．90％。结论RILT发生与功能肺的多个f-DVH参数相关，并且f-DVH对RILT具有较好的预测敏感度和特异度。Objective To investigate the correlation between functional lung dose-volume histogram （f-DVH） parameters and radiation-induced lung toxicity （RILT） in patients of locally advanced non-small cell lung cancer （NSCLC） treated with late-course accelerated hyperfractionated radiotherapy and chemotherapy, and to identify the excellent predictors of f-DVH and their reference thresholds. Methods A total of 51 patients of NSCLC at stage III underwent PET/CT/SPECT coregistered imageguided radiotherapy. Philips Pinnacle3 planning system was used for delineation of the target volume and organs at risk so as to establish the three dimensional conformal radiotherapy or intensity-modulated radiotherapy treatment plans. The version 3.0 of the NCI Common Terminology Criteria for Adverse Events was used to evaluate the grade of RILT, and analyze the correlation of the DVH parameters of the total lung （ TL）, ipsilateral lung （ IL）, and functional lung （FL） and RILT, and to identify the excellent predictors. The median follow-up was 15 months. Results During the follow-up, 10 cases of RILT （ 19.6% ） ≥ grade 2 were observed. Single factor analysis showed that the V5 - V40 of TL, V5 - V20 of IL, and V5 - V50 of FL were all related to the occurrence of RILT, and muhiple factor analysis showed that TL-V15 and FL-V20 remained associated with RILT （P = 0.005 and P = 0.016）. According to ROC analysis, the V10 （45.38%） of FL was the most sensitive predictor with a sensitivity rate of 90. 0% and V25 （27.78%） of FL was the most specific predictor with a specificity rate of 90.24%. The sensitivity, specificity and accuracy of V：o of FL were 70. 00%, 73.17%, and 74.90%, respectively. Conclusions The occurrence of RILT is closely associated with multiple f-DVH parameters of FL, and f-DVH has good sensitivity and specificity for prediction.

关 键 词：剂量体积直方图 放射性肺损伤 放射疗法 后程加速超分割 

分 类 号：R734.2[医药卫生—肿瘤]