肺癌调强或适形放疗后放射性肺炎发生及计量学预测因素研究  

Study on the Occurrence and Metrological Predictors of Radiation Pneumonia in Patients with Lung Cancer after Intensity Modulation or Conformal Radiotherapy

作　　者：马建光[1] 司小三[1] 程长海 MA Jianguang;SI Xiaosan;CHENG Changhai(Zhoukou City Central Hospital,Zhoukou,46600)

机构地区：[1]河南省周口市中心医院,466000

出　　处：《实用癌症杂志》2018年第9期1436-1438,1457,共4页The Practical Journal of Cancer

摘　　要：目的探讨肺癌接受调强或适形放疗后放射性肺炎发生及计量学预测因素。方法选取接受胸部放射治疗的肺癌患者214例,其中适形放疗96例,调强放疗118例。比较两组患者的基线数据及不同肺体积定义的计量参数对急性放射性肺炎的预测价值,并比较各因素间相关性。采用调强或适形放疗,观察患者开始至结束后3个月内急性放射性肺炎发生情况并采用肿瘤放射治疗协作组急性放射性损伤分级标准进行分级评价。结果 (1)适形放疗组出现1级以上放射性肺炎35例(36.46%),出现2级以上放射性肺炎13例(13.54%);调强放疗组出现1级以上放射性肺炎48例(40.68%),出现2级以上放射性肺炎18例(15.25%);(2)不同肺体积定义会使得肺剂量学参数值发生显著变化(P<0.01),且根据相关性分析显示V5对于大于1级放射性肺炎的发生具有更好的预测价值。综合单因素分析和Logistic多因素结果可得预测1级以上放射性肺炎发生的最有价值的指标为双肺V5、V8、V13、V20以及是否吸烟。结论调强放疗与适形放疗相比较增加了低剂量受照射的肺体积但放射性肺炎的发生率没有明显提高。不同的肺体积定义会影响正常肺剂量学,双肺V5、V8、V13、V20以及是否吸烟可能是最有价值的预测急性放射性肺炎的指标,其中对于调强放疗来说V5的预测性能可能更好。Objective To investigate the occurrence and metrological predictors of radioactive pneumonia in patients with lung cancer after intensive or conformal radiotherapy. Methods A total of 214 patients with lung cancer who underwent thoracic radiotherapy were enrolled in this study,of which 96 cases received conformal radiotherapy,118 cases received IMRT,The baseline data of the 2 groups were compared with the predictive value of the metrological parameters defined by different lung volumes for acute radiation pneumonia and the correlation between the factors was compared. The incidence of acute radiation pneumonia was observed within 3 months after the start of the patients and the acute radiation injury classification criteria were used to evaluate the acute radiation injury. Results（1）There were 35 cases（ 36. 46%） of radioative pneumonia in grade 1 and above,and 13 cases（ 13. 54%） of radioactive pneumonia occurred in grade 2 or above in conformal radiotherapy group. There were 48 cases（ 40. 68%） of radioactive pneumonia with grade 1 or more and 18 cases（ 15. 25%） with radioactive pneumonitis grade 2 or above in IMRT group.（2）The definitions of different lung volumes resulted in significant changes in the values of pulmonary dosimetry（ P 〈0. 01）,And based on the correlation analysis showed that V5 has a better predictive value for the occurrence of more than 1 grade of radiation pneumonitis. Combining with univariate analysis and Logistic multivariate analysis,the most valuable predictors for the occurrence of radiation pneumonia more than grade 1 were V5,V8,V13,V20 and smoking. Conclusion IMRT compared with conformal radiotherapy increased the volume of irradiated lungs at low doses but the incidence of radiation pneumonitis is not significantly increased. Different lung volume definitions affect normal lung dosimetry,dual lung V5,V8,V13,V20,and whether smoking may be the most valuable predictors of acute radiation pneumonitis,V5＇s predictive performance may be better for IMRT.

关 键 词：调强放疗 适形放疗 放射性肺炎 预测因素 肺体积 肺癌 

分 类 号：R734.2[医药卫生—肿瘤]