中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2012年
2期
114-120
,共7页
王静波%曹建忠%姬巍%戴建荣%吕纪马%梁军%冯勤付%陈东福%周宗玫%张红星%肖泽芬%殷蔚伯%王绿化
王靜波%曹建忠%姬巍%戴建榮%呂紀馬%樑軍%馮勤付%陳東福%週宗玫%張紅星%肖澤芬%慇蔚伯%王綠化
왕정파%조건충%희외%대건영%려기마%량군%풍근부%진동복%주종매%장홍성%초택분%은위백%왕녹화
肺肿瘤/三维放射疗法%放射性肺损伤%因素分析
肺腫瘤/三維放射療法%放射性肺損傷%因素分析
폐종류/삼유방사요법%방사성폐손상%인소분석
Lung neoplasms/three-dimensional radiotherapy%Radiation induced,lung injure%Factor analysis
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-CTC 3.0标准评估RILT级别,以放疗结束后3个月内发生的≥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1 s用力呼吸体积占预测值百分比( FEV1％)、一氧化碳弥散量占预测值百分比(DLCO％)、健肺V5～ V15、患肺V5～ V40、全肺V5～ V50、患肺及全肺的平均肺剂量(MLD)与RILT的发生相关(x2=4.46～23.99,P=0.000 ～0.035).多因素分析显示全肺MLD＞ 17.5 Gy、FEV1％ ≥72％是≥2级RILT的独立危险因素(x2=17.49、9.30,P=0.000、0.002).根据MLD和FEV1％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％(x2=25.27,P=0.000).结论 全肺MLD及放疗前FEV1％与放疗后≥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.
目的 探討跼部晚期非小細胞肺癌(NSCLC)三維放療後放射性肺損傷(RILT)與臨床和劑量學因素的關繫,以尋找RILT的可能風險因素.方法 迴顧分析2001-2007年間接受三維放療的未手術Ⅲ期NSCLC患者253例臨床和劑量學資料,採用NCI-CTC 3.0標準評估RILT級彆,以放療結束後3箇月內髮生的≥2級RILT作為終點事件,用Logistic迴歸模型分析影響RILT髮生的相關因素.結果 253例中≥2級RILT的髮生率為26.5％.單因素分析顯示年齡、放療前1 s用力呼吸體積佔預測值百分比( FEV1％)、一氧化碳瀰散量佔預測值百分比(DLCO％)、健肺V5～ V15、患肺V5～ V40、全肺V5～ V50、患肺及全肺的平均肺劑量(MLD)與RILT的髮生相關(x2=4.46～23.99,P=0.000 ～0.035).多因素分析顯示全肺MLD＞ 17.5 Gy、FEV1％ ≥72％是≥2級RILT的獨立危險因素(x2=17.49、9.30,P=0.000、0.002).根據MLD和FEV1％將患者分為低危、中危、中高危和高危組,RILT的髮生率分彆為9.3％、24.7％、38.5％和63.6％(x2=25.27,P=0.000).結論 全肺MLD及放療前FEV1％與放療後≥2級RILT髮生密切相關.基線較差的肺功能併未增加RILT風險,甚至可能具有相對較低的風險,該趨勢尚需在大樣本人群中進行驗證.
목적 탐토국부만기비소세포폐암(NSCLC)삼유방료후방사성폐손상(RILT)여림상화제량학인소적관계,이심조RILT적가능풍험인소.방법 회고분석2001-2007년간접수삼유방료적미수술Ⅲ기NSCLC환자253례림상화제량학자료,채용NCI-CTC 3.0표준평고RILT급별,이방료결속후3개월내발생적≥2급RILT작위종점사건,용Logistic회귀모형분석영향RILT발생적상관인소.결과 253례중≥2급RILT적발생솔위26.5％.단인소분석현시년령、방료전1 s용력호흡체적점예측치백분비( FEV1％)、일양화탄미산량점예측치백분비(DLCO％)、건폐V5～ V15、환폐V5～ V40、전폐V5～ V50、환폐급전폐적평균폐제량(MLD)여RILT적발생상관(x2=4.46～23.99,P=0.000 ～0.035).다인소분석현시전폐MLD＞ 17.5 Gy、FEV1％ ≥72％시≥2급RILT적독립위험인소(x2=17.49、9.30,P=0.000、0.002).근거MLD화FEV1％장환자분위저위、중위、중고위화고위조,RILT적발생솔분별위9.3％、24.7％、38.5％화63.6％(x2=25.27,P=0.000).결론 전폐MLD급방료전FEV1％여방료후≥2급RILT발생밀절상관.기선교차적폐공능병미증가RILT풍험,심지가능구유상대교저적풍험,해추세상수재대양본인군중진행험증.
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 Ⅲ 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≥2 toxicity served as the endpoint. The correlation between RILT and aforementioned factors was analyzed. Results The grade≥ 2 RILT was 26. 5％. Univariate analysis showed age, FEV1％ , DLCO％ , contralateral lung ( CL) V5 -V15 ,ipsilateral lung ( IL) V5 -V40 , total lung ( TL) V5 -Vs0 , IL and TL mean lung dose ( MLD) were significantly correlated with the development of RILT ( X2 =4. 46 - 23. 99,P = 0. 000 - 0. 035) . Mmultivariate analysis showed TL MLD ＞ 17. 5 Gy and FEV1％≥72％ were significantly correlated with the development of RILT ( X2 = 17. 49 , 9. 30, P = 0. 000 , 0. 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 FEV1％ 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.
