256例局部晚期NSCLC调强放疗后放射性肺损伤预测因素分析  

Predictive factors for radiation-induced lung injury in locally advanced non-small cell lung cancer after intensity-modulated radiotherapy

作　　者：孙帅[1,2] 陈辛元[1] 王静波[1] 吉喆[1] 毕楠[1] 周宗玫[1] 冯勤付[1] 惠周光[1] 梁军[1] 肖泽芬[1] 吕纪马[1] 王小震[1] 殷蔚伯[1] 王绿化[1] 

机构地区：[1]北京协和医学院,中国医学科学院肿瘤医院放疗科,100021 [2]北京协和医学院中国医学科学院北京协和医院放疗科

出　　处：《中华放射肿瘤学杂志》2015年第5期479-483,共5页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金项目（81272616）

摘　　要：目的：探讨局部晚期NSCLC受累野IMRT后放射性肺损伤发生率及寻找预测因素。方法2007—2011年间在我院治疗的256例未手术、Ⅲ期NSCLC患者。放疗采用受累野IMRT。放疗剂量50～70 Gy （中位值60 Gy），分割剂量2 Gy／次。109例（42．6％）接受同期化疗。采用NCI的CTCAE 3．0标准评估级别。以放疗结束后6个月内发生≥2级放射性肺损伤作为终点事件。采用Logistic回归模型对预测因素进行分析。结果所有患者中男215例（84％）、女41例（16％）。诊断时平均年龄59．2岁。43例（16．7％）发生≥2级放射性肺损伤。出现放射性肺损伤时间距放疗开始时间为20～169 d （中位数64 d）。单因素分析显示吸烟、肿瘤位置、双肺平均剂量、双肺V5—V20与≥2级放射性肺损伤发生可疑相关（ P＝0．108、0．106、0．030、0．049），多因素分析结果显示双肺平均剂量和双肺V5—V20与≥2级放射性肺损伤发生密切相关（ P＝0．048）。结论局部晚期NSCLC受累野IMRT后双肺平均剂量和DVH中低剂量区体积可以初步预测症状性放射性肺损伤发生。Objective To investigate the incidence of radiation？induced lung injury （ RILI ） in patients with locally advanced non？small cell lung cancer （ LA？NSCLC ） after involved？field intensity？modulated radiotherapy （ IMRT） and concurrent chemotherapy, and to figure out the predictive factors for RILI. Methods Two hundred and fifty？six patients with stage Ⅲ NSCLC who were treated without surgery in our hospital from January 2007 to December 2011 were enrolled as subjects. All patients received involved？field IMRT with a median dose of 60 Gy （ 50？70 Gy） in 30 fractions. In all patients, 109 patients （42.6%） received concurrent chemotherapy. The National Cancer Institute Common Terminology Criteria for Adverse Events Version 3. 0 was used to evaluate the RILI grade. The incidence of grade ≥2 RILI （ symptomatic RILI, SRILI ） within 6 months after radiotherapy served as the end point. The predictive factors for RILI were analyzed using logistic regression model. Results In all patients, 215 （ 84%） were male, and 41（16%） were female. The mean age at diagnosis was 59.2 years. Forty？three （16.7%） patients had grade ≥2 RILI. The mean duration between the incidence of RILI and the beginning of radiotherapy was 64 days （ 20？169 days） . Univariate analysis showed that smoking, peripheral or central tumor location, mean lung dose （ MLD） for both lungs, and V5？V20 for both lungs were suspected to be associated with the development of SRILI （P=0.108,0.106,0.030,0.049）. Multivariate analysis showed the MLD and V5？V20 for both lungs were independent predictive factors for SRILI P=（0.048）. Conclusions For patients with LA？NSCLC treated with involved？field IMRT, the MLD and the volume of low？dose region in dose volume histogram for both lungs are significantly correlated with the incidence of SRILI.

关 键 词：癌 非小细胞肺/调强放射疗法 癌 非小细胞肺/化学疗法 症状性放射性肺损伤 

分 类 号：R734.2[医药卫生—肿瘤]