CAJ | 학술논문

目的探讨非小细胞肺癌三维适形放疗前后肺功能的动态变化及其与放射性肺炎发生率的关系.方法 68例未手术的肺癌患者,男42例,女26例,中位年龄52岁,KPS评分≥80分,均行三维适形放疗,放疗前及放疗后1、3个月检查肺功能主要参数用力肺活量(FVC)、1 s用力呼气量(FEV1)、肺一氧化碳弥散量(CLCO),同时观察放射性肺炎的发生率及程度.结果所有患者均完成放疗,剂量为60～70 Gy.24例患者发生不同程度放射性肺炎,其中Ⅰ级11例,Ⅱ级7例,Ⅲ级3例,Ⅳ级3例,无Ⅴ级病例.FVC放疗前与放疗后3个月0级(n＝44)和Ⅰ+Ⅱ+Ⅲ+Ⅳ级(n＝24)放射性肺炎者比较,差异无统计学意义(P＞0.05),而FEV1.0和DLCO放疗前与放疗后3个月的0级(n＝44)和Ⅰ+Ⅱ+Ⅲ级+Ⅳ级(n＝24)放射性肺炎者比较,差异有统计学意义(P＜0.05).V20,V30及MLD平均值越大,放射性肺炎程度越高.结论非小细胞肺癌放疗后DLCO水平显著降低,放射性肺炎患者FEV1和DLCO放疗后显著降低.V20,V30,及MLD可预测放射性肺炎发生.
목적 탐토비소세포폐암삼유괄형방료전후폐공능적동태변화급기여방사성폐염발생솔적관계.방법 68례미수술적폐암환자,남42례,녀26례,중위년령52세,KPS평분≥80분,균행삼유괄형방료,방료전급방료후1、3개월검사폐공능주요삼수용력폐활량(FVC)、1 s용력호기량(FEV1)、폐일양화탄미산량(CLCO),동시관찰방사성폐염적발생솔급정도.결과 소유환자균완성방료,제량위60～70 Gy.24례환자발생불동정도방사성폐염,기중Ⅰ급11례,Ⅱ급7례,Ⅲ급3례,Ⅳ급3례,무Ⅴ급병례.FVC방료전여방료후3개월0급(n＝44)화Ⅰ+Ⅱ+Ⅲ+Ⅳ급(n＝24)방사성폐염자비교,차이무통계학의의(P＞0.05),이FEV1.0화DLCO방료전여방료후3개월적0급(n＝44)화Ⅰ+Ⅱ+Ⅲ급+Ⅳ급(n＝24)방사성폐염자비교,차이유통계학의의(P＜0.05).V20,V30급MLD평균치월대,방사성폐염정도월고.결론 비소세포폐암방료후DLCO수평현저강저,방사성폐염환자FEV1화DLCO방료후현저강저.V20,V30,급MLD가예측방사성폐염발생.
Objective To explore the relationships among pulmonary function,DVH and acute radiation pneumonitis after three-dimensional conformal radiation treatment in patients with non-small-cell lung cancer.Methods Pulmonary function tests were conducted on 68 inoperable patients (male 42,female 26,median age 52,KPS≥80) before and after three months radiotherapy respectively.After 3 months of follow-up,radiation pneumonitis were graded,and V20,V30 and MLD were derived from dose volume histogram (DVH).Results All patients were treated with radiotherapy at the irradiation dose of 60～70Gy.Acute radiation pneumonitis occurred in 24 patients with 11 Grade Ⅰ,7 Grade Ⅱ,3 Grade Ⅲ,3 Grade Ⅳ.There were no significant difference between the pre-irradiation and the three months after irradiation for FVC (P＞0.05).But there were significant different between pre-irradiation and three months after irradiation for FEV1.0 and DLCO (P＜0.05).V20,V30 and MLD were observed in patients treated with high radiation pneumonitis.Conclusions There were close relationships among pulmonary function,DVH and radiation pneumonitis in patients with non-small cell lung cancer.