肺功能和剂量学参数与放射性肺炎发生相关性的初步研究  

A preliminary study of the correlation between parameters of pulmonary function and lung dosimetry and the occurrence of radiation pneumonitis

作　　者：王茹 柏晗[1] 李前艳 孔银武 雷林屏 余金慧 邹育林 常莉[1] WANG Ru;BAI Han;LI Qianyan;KONG Yinwu;LEI Linping;YU Jinhui;ZOU Yulin;CHANG Li(Department of Radiation Oncology,the Third Affiliated Hospital of Kunming Medical University,Yunnan Tumor Hospital,Yunnan Kunming 650118,China)

机构地区：[1]昆明医科大学第三附属医院,云南省肿瘤医院放疗科,云南昆明650118

出　　处：《现代肿瘤医学》2024年第20期3965-3971,共7页Journal of Modern Oncology

基　　金：云南省基础研究计划项目(编号:202101AY070001-162,202101AY070001-164);云南省中青年学术和技术带头人后备人才项目(编号:202005AC160025);云南省高层次卫生健康技术人才培养专项项目(编号:D-2019030)。

摘　　要：目的:探索放疗前肺功能、肺剂量学参数与放射性肺炎(radiation pneumonitis,RP)发生的相关性。方法:回顾性分析了2020年至2023年在我院接受容积调强弧形放疗且在放疗前6个月内进行过肺功能测试的85例肺癌患者的资料,临床观测的终点为RP。使用单因素和多因素分析方法分析了患者的临床资料、肺功能、肺剂量学参数与RP发生的关系。结果:在85例患者中,39例发生了≥2级RP,发生率为45.8%。单因素分析显示,吸烟状况和放疗前肺病与≥2级RP的发生具有显著相关性(P<0.05);放疗前患者的肺功能与发生≥2级RP没有显著相关性(P>0.05);双肺V 20(WLV 20)、V 30(WLV 30)、V 40(WLV 40)和双肺平均剂量(mean lung dose,MLD)、同侧肺的V 5(ILV 5)和V 20(ILV 20)、对侧肺的V 20(CLV 20)、肿瘤PTV大小,都与≥2级RP的发生有显著相关性(P<0.05)。多因素分析显示,放疗前肺部疾病、MLD、ILV 5是发生≥2级RP的独立危险因素(P<0.05)。结论:放疗前肺功能不是预测患者RP发生的重要因素,肺部疾病、双肺的MLD以及ILV 5是预防接受容积调强弧形放疗肺癌患者2级以上RP发生的独立危险因素。Objective:To investigate the correlation between pre-radiotherapy parameters of pulmonary function and lung dosimetry and the occurrence of radiation pneumonitis(RP).Methods:The data of 85 patients with lung cancer who underwent volumetric modulated arc therapy at our hospital from 2020 to 2023 and who had undergone pulmonary function tests within six months prior to radiotherapy were retrospectively analyzed,with the clinically observed endpoint of RP.The relationship between patients'clinical data,pulmonary function parameters,and lung dosimetry parameters and the occurrence of RP was analyzed using univariate and multivariate analysis methods.Results:In the group of 85 patients,39 developed grade≥2 RP,with an incidence rate of 45.8%.Univariate analysis showed that smoking status and pre-radiotherapy lung disease were significantly correlated with the occurrence of grade≥2 RP(P<0.05).The lung function of patients before radiotherapy was not significantly correlated with the occurrence of grade≥2 RP(P>0.05).The V 20(WLV 20),V 30(WLV 30),V 40(WLV 40),and the mean lung dose(MLD)in whole lung,V 5(ILV 5)and V 20(ILV 20)in the ipsilateral lung,V 20(CLV 20)in the contralateral lung,and tumor PTV size were all significantly correlated with the occurrence of grade≥2 RP(P<0.05).Multivariate analysis showed that pre-radiotherapy lung disease,MLD,and ILV 5 were independent risk factors for the occurrence of grade≥2 RP(P<0.05).Conclusion:Pre-radiotherapy lung function is not an important predictor of the occurrence of RP in patients.Lung disease,MLD in whole lung,and ILV 5 are independent risk factors for preventing the occurrence of grade 2 or higher RP in lung cancer patients treated with volumetric modulated arc therapy.

关 键 词：肺功能 剂量学参数 放射性肺炎 相关性 

分 类 号：R730.231[医药卫生—肿瘤]