摘要
目的目前用于预测放射性肺炎(radiation pneumonitis,RP)的剂量学参数基本上都是基于三维适形放疗(three⁃dimensional conformal radiotherapy,3D⁃CRT)技术。而肺癌的根治性放疗更提倡使用调强放疗(intensity⁃modulated radiotherapy,IMRT),但目前尚未建立基于IMRT预测RP的剂量学参数。本研究拟寻找接受根治性IMRT的非小细胞肺癌(non⁃small cell lung cancer,NSCLC)患者发生RP的最佳预测因子。方法回顾性分析2014年至2019年在广东省人民医院放疗科接受根治性IMRT的NSCLC患者。主要研究终点为≥2度的RP(RP2)。提取的肺部剂量学参数分别有V5、V10、V20、V30、V40以及肺平均剂量(mean lung dose,MLD)。正常肺部的体积分别定义为双侧肺减去大体肿瘤体积GTV(lung-gross tumor volume,Lung-GTV)、双侧肺减去临床靶体积(lung-clinical target volume,Lung-CTV)、双侧肺减去计划靶体积(lung-planning target volume,Lung-PTV)。分析RP2与肺部剂量学参数的相关性。结果共纳入73例患者进行分析,RP2发生率为14.9%,年龄>60岁以及序贯化放疗是发生RP2的高危因素。无论是哪一种肺部定义方式,V10都与RP2显著相关。其中V10 Lung-GTV与RP2的相关性最强(P=0.01,AUC=0.776)。结论肺部V10与RP2的发生显著相关。V10 Lung-GTV可作为接受IMRT根治性放疗的NSCLC发生RP2的最佳预测因子。
Objective At present,the dosimetric parameters used to predict radiation pneumonia(RP)are almost based on three⁃dimensional conformal radiotherapy(3D⁃CRT).Intensity modulated radiation therapy(IMRT)is more recommended for radical radiotherapy of lung cancer,but the dosimetric parameters for RP prediction based on IMRT have not been established.This study aims to find the best predictor of RP in non⁃small cell lung cancer(NSCLC)patients receiving radical IMRT.Methods NSCLC patients who received radical IMRT in the Department of Radiotherapy of Guangdong Provincial People's Hospital from 2014 to 2019 were retrospectively analyzed.The primary endpoint was RP of degrees 2 or more(RP2).The lung dosimetric parameters were V5,V10,V20,V30,V40 and mean lung dose(MLD).The volume of normal lung was defined as bilateral lung minus gross tumor volume(Lung-GTV),bilateral lung minus clinical target volume(Lung-CTV),bilateral lung minus planning target volume(Lung-PTV).The correlation between RP2 and lung dosimetric parameters was analyzed.Results A total of 73 patients were included in the analysis.The incidence of RP2 was 14.9%.Age>60 years old and sequential chemoradiotherapy were the high risk factors of RP2.Regardless of the lung definition,V10 was significantly associated with RP2.The correlation between V10 Lung-GTV and RP2 was the strongest(P=0.01,AUC=0.776).Conclusions V10 was significantly associated with the development of RP2.V10 Lung-GTV was the best predictor of RP2 in NSCLC patients receiving IMRT.
作者
黄唯
谭佩欣
吕凤泉
刘平平
潘燚
HUANG Wei;TAN Pei-xin;LV Feng-quan;LIU Ping-ping;PAN Yi(Department of Radiotherapy,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)
出处
《循证医学》
2020年第5期300-305,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基金(8190120260)
广东省人民医院国自然配套启动基金(8197110946)。
关键词
放射性肺炎
剂量学参数
放疗
非小细胞肺癌
radiation pneumonitis
dosimetric parameters
radiotherapy
non⁃small cell lung cancer
