肺脏低剂量区体积预测食管癌三维适形放疗所致急性放射性肺炎的价值  

Low dose volume histogram analysis of the lungs in prediction of acute radiation pneumonitis inpatients with esophageal cancer treated with three-dimensional conformal radiotherapy

作　　者：沈文斌[1] 祝淑钗[1] 高红梅[2] 李幼梅[1] 刘志坤[1] 李娟[1] 苏景伟[1] 万钧[1] 

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011 [2]石家庄市第一医院放射科

出　　处：《中华肿瘤杂志》2013年第1期45-49,共5页Chinese Journal of Oncology

摘　　要：目的探讨肺脏低剂量区体积预测食管癌单纯三维适形放疗（3D-CRT）所致急性放射性肺炎（RP）的价值，并确定肺脏V5（接受5Gy照射时的肺脏体积占全肺总体积的百分比）与双侧肺脏受照平均肺剂量（MLD）和肺脏V加不同组合预测RP发生的最优组合。方法选取接受单纯根治性3D-CRT的食管癌患者222例，观察并记录双侧肺脏接受5、10、15、20、25和30Gy照射时的肺脏体积占全肺总体积的百分比（V5、V10、V15、V20、V25、V30）和双侧肺脏MLD，对患者临床资料和治疗计划等进行单因素和多因素分析。结果222例患者中，发生1级急性RP者68例（30．6％）、2级40例（18．0％）、3级8例（3．6％）、4级1例（0．5％）。单因素分析结果显示，射野数、大体肿瘤体积、双侧肺脏MLD、肺脏V，、Vlo、V15、V20、V25和V30均与≥1级和≥2级急性RP的发生有关（均P〈0．05）。多因素分析结果显示，双侧肺脏MLD、肺脏V5、V20和V25为食管癌患者发生≥1级急性RP的独立影响因素（均P〈0．05）；射野数、双侧肺脏MLD和肺脏V5为食管癌患者发生≥2级急性RP的独立影响因素（均P〈0．05）。以双侧肺脏MLD、肺脏V5和V20的分界值（分别为14Gy、60％和28％）进行不同组合，当患者双侧肺脏MLD≤14Gy＋肺脏V5≤60％＋V20≤28％时，≥1级和≥2级急性RP的发生率均减低（均P〈0．05）；当肺脏u。≤28％＋U≤60％时，≥1级和〉t2级急性RP的发生率均减低（均P〈0．05）；当双侧肺脏MLD≤14Gy＋V5≤60％时，≥1级急性RP的发生率减低（P〈0．05）；当双侧肺脏MLD〉14Gy＋V5≤60％时，≥2级急性RP的发生率减低（P〈0．05）。结论肺脏低剂量区体积与食管癌单纯3D-CRT所致急性RP的发生密切相关；双侧肺脏MLD、肺脏V5和V20组合有可能提高预测急性RP发生的能力。Objective To investigate the predictive value of low dose volume of the lung on acute radiation pneumonitis （RP） in patients with esophageal cancer treated with three-dimensional conformal radiotherapy （3D-CRT） only, and to analyze the relation of comprehensive parameters of the dose-volume V5, V20 and mean lung dose （MLD） with acute RP. Methods Two hundred and twenty-two patients with esophageal cancer treated by 3D-CRT have been followed up. The V5-V30 and MLD were calculated from the dose-volume histogram system. The clinical factors and treatment parameters were collected and analyzed. The acute RP was evaluated according to the RTOG toxicity criteria. Results The acute RP of grade 1,2, 3 and 4 were observed in 68 （30.6%）, 40 （ 18.0% ） , 8 （3.6%） and 1 （0.5%） cases, respectively. The univariate analysis of measurement data：The primary tumor length, radiation fields, MLD and lung V5- V30 had a significant relationship with the acute RP. The magnitude of the number of radiation fields, the volume of GTV, MLD and Lung V5-V30 had a significant difference in whether the ≥ grade 1 and ≥ grade 2 acute RP developed or not. Binary logistic regression analysis showed that MLD, Lung V5, V20 and V25 were independent risk factors of ≥ grade I acute RP, and the radiation fields, MLD and Lung V5 wereindependent risk factors of ≥ grade 2 acute RP. The ≥ grade 1 and ≥ grade 2 acute RP were significantly decreased when MLD less than 14 Gy, V5 and V20 were less than 60% and 28% ,respectively. When the V20 ≤28%, the acute RP was significantly decreased in V5 ≤60% group. When the MLD was ≤14 Gy, the ≥ 1 grade acute RP was significantly decreased in the V5 ≤60% group. When the MLD was 〉 14 Gy, the ≥grade 2 acute RP was significantly decreased in the V5 ≤60% group. Conclusions The low dose volume of the lung is effective in predicting radiation pneumonitis in patients with esophageal cancer treated with 3D- CRT only. The comprehensive parameters combined with V5, V20 and MLD

关 键 词：食管肿瘤 放射疗法 适形 肺低剂量区体积 辐射性肺炎 

分 类 号：R735.1[医药卫生—肿瘤]