摘要
目的:探讨放射性肺炎发生相关的临床及剂量体积因素,指导非小细胞肺癌放疗计划的制定,减少放射性肺损伤的友生。方法:回顾性分析2004年3月～2007年12月在河北医科大学第四医院放疗科接受累及野照射的三维适形放疗局部晚期非小细胞肺癌115例。在肺窗条件下勾画大体肿瘤体积CTV1和纵隔窗条件下短径≥10mm的淋巴结GTV2。临床靶体积(CTV)为CTV1外放8mm,及肿大淋巴结累及区计划靶区(PTV)为CTV外放5～10mm。6MV-X线照射,1.8～2.0Gy/次,5次/周、PTV剂量达50～70Gy,中位剂量60Gy。其中42例单纯放疗,73例放、化疗结合治疗。记录临床因素与剂量体积(DVH)参数及放疗结束3个月内发生的≥2级放射性肺炎。放射性肺炎采用RTOG急性放射性损伤分级标准。统计分析使用SPSS 13.0软件包。结果:33例发生2级及以上RP,发生率为28.7%。中位发生时间为2个月。单因素分析显示性别、是否合并基础肺疾病、全肺体积、V5、V10、D50、D75与RP发生相关,差异有统计学意义(P=0.013、0.020、0.024、0.006、0.016、0.014、0.044)。多因素分析显示合并基础肺疾病及V5是放射性肺炎发生的独立危险因素(P=0.022、0.004)。结论:DVH参数与放射性肺炎的发生相关,其中V5是预测RP的剂量学指标,在制定治疗计划时还应考虑患者是否合并基础肺疾病以减少RP发生。
Objective： To study the clinical and DVH parameters associated with the radiation pneumonitis（RP） after three-dimensional conformal radiotherapy （3DCRT） for non-small cell lung cancer （NSCLC）.Methods： A total of 115 patients with NSCLC treated with 3DCRT between March 2004 and December 2007were analyzed and evaluated. The GTV1 of the primary tumor and GTV2 of the enlarged mediastinal lymphnodes, and CTV and PTV were outlined respectively. The PTV dose was over 50Gy, with 1.8～2.0Gy perfraction, once a day, five fractions per week. Fourty-two patients received radiotherapy alone and 73 patientsreceived chemoradiotherapy. The clinical factors, DVH parameters and Grade 2 or higher pneumonitisobserved within 3 months after radiotherapy were recorded. SPSS13.0 software was used for statisticalanalysis. Results： Thirty-three patients （28.70%） were observed with Grade 2 or higher RP. The onset timewas at 2 months after radiotherapy. Univariate analysis showed that the total lung volume, V10, D50, and D75were risk factors for RP （P=0.024, 0.016, 0.014 and 0.044）. Univariate and multivariate analysis revealed thatother pulmonary diseases before radiotherapy and V5 were independent risk factors for RP （P=0.022 and0.004）. Conclusion： DVH parameters are associated with the occurrence of RP. V5 and other pulmonarydiseases are independent risk factors for RP in patients with non-small cell lung cancer.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2009年第19期1086-1089,共4页
Chinese Journal of Clinical Oncology
基金
河北省科技厅支持项目(编号:012761224)
河北省普通高校强势特色学科项目资助(编号:2005-52)~~
关键词
非小细胞肺癌
三维适形放射治疗
放射性肺炎
Non-small cell lung cancer
Three-dimensional conformal radiotherapy
Radiation pneumonitis
