肺低剂量区体积与非小细胞肺癌放疗致放射性肺损伤的关系  

Relationship between low-dose radioactive zone volume and radiation-induced lung injury in patients with non-small cell lung cancer

作　　者：吕秋波[1] 王炳胜[2] 刘秀芳[2] 赵增虎[2] 张海[2] 

机构地区：[1]河北承德医学院研究生院,承德067000 [2]中国人民解放军第251医院放疗科,张家口075000

出　　处：《中国癌症防治杂志》2016年第5期299-303,共5页CHINESE JOURNAL OF ONCOLOGY PREVENTION AND TREATMENT

摘　　要：目的探讨肺低剂量区体积剂量学参数与非小细胞肺癌(non small cell lung cancer,NSCLC)放疗致放射性肺损伤(radiation induced lung injury,RILI)的关系。方法收集103例NSCLC放疗患者,通过放疗计划及剂量体积直方图(DVH)获得全肺、患侧肺、健侧肺的剂量体积参数和平均肺受照射剂量(MLD),采用单因素分析各剂量学参数与≥2级RILI发生的相关性,制作受试者工作特征曲线(ROC),评价各剂量学参数对RILI的预测价值。结果发生≥2级RILI者27例,发生率为26.2%。≥2级RILI患者双肺V_5、双肺MLD、患侧肺V_5、患侧肺V_(10)、健侧肺V_5的相对肺体积均高于<2级RILI者,差异均有统计学意义(P<0.05)。ROC曲线分析显示,双肺V_5、双肺MLD、患侧肺V_5、患侧肺V_(10)、健侧肺V_5曲线下面积分别为0.714、0.673、0.690、0.693、0.737,当双肺V_5≥52.22%、双肺MLD≥1 486.75 cGy、患侧肺V5≥62.03%、健侧肺V_5≥43.60%、患侧肺V_(10)≥55.67%均可导致肺癌患者≥2级RILI发生率升高(P<0.001)。结论临床制定NSCLC患者根治性放疗计划时,不仅要限定V_(20)、V_(30)、MLD,还应注意低剂量区体积V_5对放射性肺损伤的影响。To analyze the relationship between low-dose radiation dosimetry parameters and occurrence of radiation-induced lung injury in patients with non-small cell lung cancer（NSCLC）. Methods Medical records were retrospectively analyzed for 103 patients with NSCLC who received radiation therapy. Single-factor analysis was used to explore correlations of dosimetric parameters and occurrence of grade 2 or higher radiation-induced lung injury. Parameters that significantly predicted injury were assessed for their predictive ability by examining the area under the receiver operating characteristic curve（AUC）. Results Of the 103 patients,27（26.2%）experienced radiation-induced lung injury of grade 2 or higher. Dosimetric parameters showed the following AUCs for predicting such injury： double lung V5,0.714;double lung MLD,0.673;ipsilateral lung V5,0.690;ipsilateral lung V10,0.693;and healthy contralateral lung V5,0.737. Incidence of radiation-induced lung injury was significantly higher in patients with double lung V5 ≥52.22%,double lung MLD≥1 486.75 cGy,ipsilateral lung V5 ≥62.03%,healthy contralateral lung V5 ≥43.60%,or ipsilateral lung V10 ≥55.67%. Conclusion Radical radiotherapy planning should take into account the influence of low-dose radiation on risk of radiation-induced lung injury.Except common parameters,such as V20,V30 and MLD,V5 should also be considered.

关 键 词：肺肿瘤 放射治疗 肺低剂量区体积 放射性肺损伤 预测指标 

分 类 号：R734.2[医药卫生—肿瘤]