Ⅲ+Ⅳ期非小细胞肺癌调强放疗剂量学参数预测有症状放射性肺炎的临床研究  

Symptomatic radiation pneumonitis following intensity modulated radiotherapy for stage Ⅲ and Ⅳ non- small cell lung cancer:Dose-volume histogram analysis

作　　者：陈银[1] 王晓萍[1] 孙向东[1] 华海清[2] 张新良[1] 

机构地区：[1]南京中医药大学附属南京八一医院全军肿瘤中心放疗科,江苏南京210002 [2]南京中医药大学附属南京八一医院全军肿瘤中心肿瘤内科,江苏南京210002

出　　处：《现代肿瘤医学》2017年第4期561-565,共5页Journal of Modern Oncology

基　　金：南京军区医学科技创新课题资助项目(编号:09MA045)

摘　　要：目的:探讨接受调强放疗(intensity modulated radiotherapy,IMRT)的Ⅲ、Ⅳ期非小细胞肺癌(nonsmall-cell lung cancer,NSCLC)患者正常肺组织剂量-体积参数对有症状放射性肺炎(≥2级,radiation pneumonitis,RP)的预测作用。方法 :回顾性分析53例接受调强放疗的Ⅲ、Ⅳ期NSCLC患者临床资料,记录剂量-体积参数V5、V20、平均肺剂量(MLD)及≥2级RP发生率。肺损伤评估根据CTCAE4.0标准。单因素及多因素分析各个剂量学参数与≥2级RP之间的关系,并采用ROC曲线分析各剂量参数的敏感性、特异性对预测≥2级RP的价值。结果:53例患者中2级RP发生率为9.43%(5/53),3级RP发生率为5.66%(3/53),4级RP发生率为3.77%(2/53),≥2级RP总发生率为18.87%(10/53)。经Spearman等级相关分析,V5、V20、MLD均与≥2级RP的发生相关(r=0.485、0.404、0.404,P=0.000、0.003、0.003)。单因素分析发现V5、V20、MLD与≥2级RP的发生有相关性(t=-4.588、-2.433、-2.845,P=0.000、0.019、0.006)。经单因素分析中有意义的参数,再次进行多因素分析显示:V5是≥2级RP发生的独立影响因素(P=0.03)。经ROC曲线分析,V5预测≥2级RP有统计学意义(P<0.05),其曲线下面积为0.862,敏感性和特异性分别为1.00、0.442。当V5临界值为43.65%时≥2级RP发生率分别为7.14%、32%。结论:剂量-体积参数V5、V20、MLD与≥2级RP相关,其中V5是独立预测因素。Objective： To determine lung dosimetric constraints that correlated with symptomatic radiation pneumonitis（ ≥2 grade） in stage Ⅲ and Ⅳ non- small cell lung cancer patients treated with intensity modulated radiotherapy（ IMRT）. Methods： 53 NSCLC patients were treated with IMRT. Several dosimetric factors and ≥2 grade RP incidence were recorded and analyzed. Radiation induced lung injury was evaluated according to the standard CTCAE4. 0.Univariate and multivariate analyses were performed to assess the relationship between dosimetric factors and ≥ 2grade RP. The ROC curve was used to explore the predictive sensitivity（ SEN） and specificity（ SPE） for potential DVH parameters associated with ≥2 grade RP. Results：The morbidity of ≥2 grade RP was 18. 87 %,and grade of 2,3,and 4 were 9. 43 %,5. 66 %,3. 77 %,respectively. According to Spearman rank correlation analyses,V5,V20,MLD were the prognostic factors associated with RP of grade 2 or greater（ r = 0. 485,0. 404,0. 404,P = 0. 000,0. 003,0. 003）. According to univariate analyses,V5,V20,MLD were significantly related to RP of grade 2 or greater（ t =- 4. 588,- 2. 433,- 2. 845,P = 0. 000,0. 019,0. 006）. According to multivariate analyses,V5 was the only factor associated with RP of grade 2 or greater（ P = 0. 03）. According to ROC curve analyses,V5 was valuable in predicting RP of grade 2 or greater. If predictive cut- off values was established as follows： V5= 0. 862,the parameters could provide predictive SEN,SPE were 1. 00 and 0. 442. And RP incidence of grade 2 or greater were 7. 14 % and 32 % in patients with a V5 of 43. 65 % and ≥43. 65 %,respectively. Conclusion：Dosimetric factors are associated with RP of grade 2 or greater,and the incidence and grade of RP are significantly related to the V5 value.

关 键 词：非小细胞肺癌 放射治疗 放射性肺炎 剂量-体积直方图 

分 类 号：R734.2[医药卫生—肿瘤]