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中国癌症防治杂志

中国癌症防治杂志 ›› 2016, Vol. 8 ›› Issue (5): 299-303.doi: 10.3969/j.issn.1674-5671.2016.05.08

• 临床研究 • 上一篇    下一篇

肺低剂量区体积与非小细胞肺癌放疗致放射性肺损伤的关系

  

  1. 河北承德医学院研究生院；中国人民解放军第251医院放疗科
  • 出版日期:2016-10-25 发布日期:2016-11-14
  • 通讯作者: 王炳胜 357244529@qq.com

Relationship between low-dose radioactive zone volume and radiation-induced lung injury in patients with non?鄄small cell lung cancer

  • Online:2016-10-25 Published:2016-11-14

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被引次数

5

摘要：

目的 探讨肺低剂量区体积剂量学参数与非小细胞肺癌（non small cell lung cancer，NSCLC)放疗致放射性肺损伤（radiation induced lung injury，RILI）的关系。方法 收集103例NSCLC放疗患者，通过放疗计划及剂量体积直方图（DVH）获得全肺、患侧肺、健侧肺的剂量体积参数和平均肺受照射剂量（MLD），采用单因素分析各剂量学参数与≥2级RILI发生的相关性，制作受试者工作特征曲线（ROC），评价各剂量学参数对RILI的预测价值。结果 发生≥2级RILI 者27例，发生率为26.2%。≥2级RILI患者双肺V5、双肺MLD、患侧肺V5、患侧肺V10、健侧肺V5的相对肺体积均高于＜2级RILI者，差异均有统计学意义（P＜0.05）。ROC曲线分析显示，双肺V5、双肺MLD、患侧肺V5、患侧肺V10、健侧肺V5曲线下面积分别为0.714、0.673、0.690、0.693、0.737，当双肺V5≥52.22%、双肺MLD≥1 486.75 cGy、患侧肺V5≥62.03%、健侧肺V5≥43.60%、患侧肺V10≥55.67%均可导致肺癌患者≥2级RILI发生率升高（P＜0.001）。 结论 临床制定NSCLC患者根治性放疗计划时，不仅要限定V20、V30、MLD，还应注意低剂量区体积V5对放射性肺损伤的影响。

关键词: 肺肿瘤, 放射治疗, 肺低剂量区体积, 放射性肺损伤, 预测指标

Abstract:

 Objective  To analyze the relationship between low-dose radiation dosimetry parameters and occurrence of radiation-induced lung injury in patients with non-small cell lung cancer（NSCLC）. Methods  Medical records were retrospectively analyzed for 103 patients with NSCLC who received radiation therapy. Single-factor analysis was used to explore correlations of dosimetric parameters and occurrence of grade 2 or higher radiation-induced lung injury. Parameters that significantly predicted injury were assessed for their predictive ability by examining the area under the receiver operating characteristic curve（AUC）. Results  Of the 103 patients，27（26.2%）experienced radiation-induced lung injury of grade 2 or higher. Dosimetric parameters showed the following AUCs for predicting such injury: double lung V5，0.714；double lung MLD，0.673；ipsilateral lung V5，0.690；ipsilateral lung V10，0.693；and healthy contralateral lung V5，0.737. Incidence of radiation-induced lung injury was significantly higher in patients with double lung V5 ≥52.22%，double lung MLD≥1 486.75 cGy，ipsilateral lung V5 ≥62.03%，healthy contralateral lung V5 ≥43.60%，or ipsilateral lung V10 ≥55.67%. Conclusion Radical radiotherapy planning should take into account the influence of low-dose radiation on risk of radiation-induced lung injury.Except common parameters，such as V20，V30 and MLD，V5 should also be considered.

Key words: Lung neoplasm, Radiotherapy, Lung low-dose radioactive zone volume, Radiation-induced lung injury, Predictors