驱动基因阳性局部晚期非小细胞肺癌靶向治疗序贯根治性放疗发生有症状放射性肺炎的风险因素分析  

Risk Factors of Symptomatic Radiation Pneumonitis in Patients With Driver Gene Positive Locally Advanced Non⁃Small Cell Lung Cancer After Targeted Therapy Followed by Sequential Radical Radiotherapy

作　　者：谭佩欣[1] 黄唯 张红丹[1] 杜钦文 潘燚[1] TAN Pei-xin;HUANG Wei;ZHANG Hong-dan;DU Qin-wen;PAN Yi(Department of Radiotherapy,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省人民医院放疗科、广东省医学科学院,广州510080

出　　处：《循证医学》2020年第4期246-251,共6页The Journal of Evidence-Based Medicine

基　　金：广东省医学科学技术研究基金资助项目(B2020024);广东省人民医院国自然配套启动资金资助项目(8190120260);广东省人民医院院内启动基金资助项目(8197110946);吴阶平医学基金资助项目(320.6750.19089⁃1)。

摘　　要：目的评估驱动基因阳性局部晚期非小细胞肺癌(non⁃small cell lung cancer,NSCLC)靶向治疗序贯根治性放疗有症状放射性肺炎(radiation pneumonitis,RP)的发生率及风险因素。方法回顾性分析2017年1月至2020年4月在广东省人民医院接受靶向治疗序贯胸部放疗的不可手术Ⅲ期NSCLC患者。采用不良反应评价标准5.0版进行RP分级,≥2级定义为有症状RP。使用χ2检验以及Kruskal Wallis检验评估潜在的临床及剂量学危险因素。结果13例入组患者,其中6例(46.1%)发生有症状RP。2级RP 5例,3级RP 1例。经激素治疗后所有RP均转归为肺纤维化1~2级。单因素分析结果显示年龄、慢性阻塞性肺炎病史等临床因素与≥2级RP不相关,V20、肺平均受量等剂量学因素均未见与≥2级RP相关。结论靶向治疗序贯胸部放疗后≥2级RP的发生率较高,未发现与有症状RP相关的临床或剂量学危险因素。Objective To evaluate the incidence and risk factors of symptomatic radiation pneumonitis(RP)in patients with driver gene positive locally advanced non⁃small cell lung cancer(NSCLC).Methods From January 2017 to April 2020,patients with inoperable stageⅢNSCLC who received targeted therapy followed by sequential thoracic radiotherapy in Guangdong Provincial People􀆳s Hospital were retrospectively analyzed.Radiation pneumonitis was graded according to the common terminology criteria for adverse events 5.0.The symptomatic RP was defined as≥grade 2.Chi square test and nonparametric Kruskal Wallis test were used to evaluate the potential clinical and dosimetric risk factors.Results Among the 13 patients,6(46.1%)had symptomatic RP.There were 5 cases of≥grade 2 RP and 1 case of grade 3 RP.After steroid treatment,all RP were recovered and resulted in pulmonary fibrosis grade 1~2.Univariate analysis showed that age,history of chronic obstructive pneumonia and other clinical factors were not associated with≥grade 2 RP.Dose factors such as V20 and average lung dose were not related to≥grade 2 RP.Conclusion Theincidence of≥grade 2 RP after targeted therapy followed by sequential radiotherapy is high.No clinical or dosimetric risk factors related to symptomatic RP were found.

关 键 词：非小细胞肺癌 靶向治疗 放疗 放射性肺炎 

分 类 号：R734.2[医药卫生—肿瘤]