摘要
目的探讨非小细胞肺癌三维适形放疗所致重度（≥3级）放射性肺炎（RP）与剂量体积直方图（DVH）参数之间的关系。方法94例非小细胞肺癌患者予以三维适形放疗，对临床参数及DVH参数与重度RP发生的关系进行单因素、多因素Logistic分析。结果年龄、性别、KPS评分、第1秒用力呼气容积、体重减轻、肺基础疾病、外科手术史和化疗史与重度RP的发生差异无统计学意义（P〉0．05）。单因素Logistic回归分析结果显示，除了总剂量以外，受到20、30或40Gy以上剂量照射的肺体积占全肺总体积的百分数（V20、V30、V40）、平均剂量（MLD）和正常组织并发症概率（NTCP）与重度RP的发生差异均有统计学意义（P〈0．01）；在多因素Loostic回归分析中，MLD、V30与重度RP的发生差异有统计学意义（P〈0．01）；当MLD〈10Gy、10—20Gy、〉20Gy时，重度RP的发生率分别为0、21％（8／39）、35％（7／20），当V30〈25％、25％～35％、〉35％时，重度RP的发生率分别为0、12％（4／33）、38％（11／29）。结论MLD和V30是重度RP发生的重要预测因素，应该分别被限制到≤20Gy和≤35％，以减少重度RP的发生。
Objective To explore the relationship between severe（ ≥grade 3） radiation pneumonitis （RP） and dose-volume histogram （DVH） parameters for non-small cell lung cancer （NSCLC） treated with three-dimensional conformal radiation therapy （3-DCRT）. Methods Ninety-four patients with NSCLC treated with 3-DCRT were retrospectively analyzed. Clinical parameters were analyzed. DVH parameters analyzed were V20, V30, V40, mean lung dose （ MLD ）, normal tissue complication probability（NTCP）, and total dose. Results Age, sex, Karnofsky scored, performance status, forced expiratory volume in 1 second,presence of weight loss, preexisting lung disease, history of thoracic surgery, and history of chemotherapy were not associated with the risk of severe RP （P 〉 0.05）. However, in univariate analyses, V20, V30, V40, MLD and NTCP were associated with severe RP（P 〈 0.01 ）. In multivariate analysis, MLD and V30 were variable associated with severe RP （P〈 0.01 ）. The severe RP was 0 when MLD 〈 10 Gy and 21%（8/39） when MLD between 10 Gy and 20 Gy but 35%（7/20） when MLD 〉 20 Gy,it was 0 when V30 〈 25% and 12%（4/33） when V30 between 25% and 35% but 38%（11/29） when V30 〉 35%. Conclusion MLD and V30 are significant predictive factors for severe RP and they should be limited to ≤20 Gy and ≤ 35% in order to reduce severe RP.
出处
《中国医师进修杂志》
2010年第20期1-3,共3页
Chinese Journal of Postgraduates of Medicine
关键词
癌
非小细胞肺
放射治疗剂量
辐射性肺炎
剂量体积直方图
Carcinoma,non-small cell lung
Radio therapy dosage
Radiation pneumonitis
Dose-volume histogram
