摘要
目的探讨局部晚期非小细胞肺癌（NSCLC）三维放疗后放射性肺损伤（RILT）与临床和剂量学因素的关系，以寻找RILT的可能风险因素。方法回顾分析2001-2007年间接受三维放疗的未手术Ⅲ期NSCLC患者253例临床和剂量学资料，采用NCI-CTC3．0标准评估RILT级别，以放疗结束后3个月内发生的I〉2级RILT作为终点事件，用Logistic回归模型分析影响RILT发生的相关因素。结果253例中≥2级RILT的发生率为26．5％。单因素分析显示年龄、放疗前1s用力呼吸体积占预测值百分比（FEVl％）、一氧化碳弥散量占预测值百分比（DLCO％）、健肺V，～V。患肺V，～V4。、全肺V5-V50、患肺及全肺的平均肺剂量（MLD）与RILT的发生相关（X^2=4．46-23．99，P=0．000-0．035）。多因素分析显示全肺MLD〉17．5Gy、FEVl％I〉72％是I〉2级RILT的独立危险因素（X^2=17．49、9．30，P=0．000、0．002）。根据MLD和FEVl％将患者分为低危、中危、中高危和高危组，RILT的发生率分别为9．3％、24．7％、38．5％和63．6％（f=25．27，P=0．000）。结论全肺MLD及放疗前FEVl％与放疗后i〉2级RILT发生密切相关。基线较差的肺功能并未增加RILT风险，甚至可能具有相对较低的风险，该趋势尚需在大样本人群中进行验证。
Objective To investigate the patient and treatment related predictors for the development of radiation induced lung toxicity （RILT） in patients with locally advanced non-small cell lung cancer （NSCLC） receiving definitive three-dimensional radiotherapy. Methods Data were retrospectively collected from inoperable or unresectable 253 patients with stage m NSCLC treated with definitive three- dimensional radiotherapy between January 2001 and April 2007. National cancer institute common toxicity criteria version 3.0 was employed to evaluate the classification of RILT and grade 〉12 toxicity served as the endpoint. The correlation between RILT and aforementioned factors was analyzed. Results The grade I〉 2 RILT was 26. 5%. Univariate analysis showed age, FEVI% , DLCO% , contralateral lung （CL） Vs-VIs, ipsilateral lung （IL） Vs-V40, total lung （TL） Vs-Vs0, IL and TL mean lung dose （MLD） were significantly correlated with the development of RILT （ X2 = 4.46 - 23.99,P = 0. 000 - O. 035 ）. Mmultivariate analysis showed TL MLD 〉 17.5 Gy and FEVI% I〉72% were significantly correlated with the development of RILT （ X2 = 17.49,9.30, P = 0. 000, O. 002 ）. Patients were stratified into four groups according to MLD and FEV1% , corresponding to the RILT incidence of 9. 3% , 24.7%, 38.5% and 63.6% , respectively （X2 = 25.27, P = 0. 000）. Conclusions TL MLD and baseline FEV1% are significant factors correlated with the development of RILT in NSCLC patients treated with three-dimensional radiation therapy. The combination of TL MLD and FEVI% may help classify NSCLC patients per risk of RILT and subsequently direct risk- adaptive radiation therapy. Poor baseline pulmonary function does not increase the risk of RILT and may even be associated with lower RILT probability, which has yet to be validated in larger patient cohorts.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2012年第2期114-120,共7页
Chinese Journal of Radiation Oncology
关键词
肺肿瘤/三维放射疗法
放射性肺损伤
因素分析
Lung neoplasms/three-dimensional radiotherapy
Radiation induced lung injure
Factor analysis
