中华放射医学与防护杂志
中華放射醫學與防護雜誌
중화방사의학여방호잡지
Chinese Journal of Radiological Medicine and Protection
2011年
3期
308-311
,共4页
王冬青%李宝生%孙洪福%张健%卢洁%刘波%李洪升%马长升
王鼕青%李寶生%孫洪福%張健%盧潔%劉波%李洪升%馬長升
왕동청%리보생%손홍복%장건%로길%류파%리홍승%마장승
剂量体积直方图%放射性肺损伤%放射疗法%后程加速超分割
劑量體積直方圖%放射性肺損傷%放射療法%後程加速超分割
제량체적직방도%방사성폐손상%방사요법%후정가속초분할
Dose-volume histogram%Radiation-induced lung toxicity%Radiotherapy%Latecourse accelerated hyperfraction
目的 探讨功能肺剂量体积直方图(f-DVH)参数与后程加速超分割放疗诱导的放射性肺损伤(RILT)的相关性,筛选敏感度、特异度、准确性较高的f-DVH预测因子及其参考阈值.方法 行PET/CT/SPECT融合影像引导胸部精确放疗的Ⅲ期非小细胞肺癌(NSCLC)患者51例,在Philips Pinnacle3治疗计划系统勾画肿瘤靶区和周围危及器官,制定三维适形或凋强放疗计划.采用NCI CTC3.0标准对RILT进行分级.分析双侧肺、同侧肺以及功能肺DVH参数与RILT的相关性,筛选预测RILT的最佳参数及其阈值.结果 中位随访15个月,有10例(19.6%)发生≥2级RILT.单因素分析双侧肺V5～V40,同侧肺V5～V20,功能肺V5～V50与≥2级RILT发生有关,多因素分析显示双侧肺V15、功能肺V20与RILT相关(P=0.005,0.016).ROC曲线分析显示功能肺V10(45.38%)预测敏感度最高,为90%;功能肺V25(27.78%)预测特异度最高,为90.24%;功能肺V20(29.61%)预测的敏感度、特异度、准确性分别达到70.00%、73.17%、74.90%.结论 RILT发生与功能肺的多个f-DVH参数相关,并且f-DVH对RILT具有较好的预测敏感度和特异度.
目的 探討功能肺劑量體積直方圖(f-DVH)參數與後程加速超分割放療誘導的放射性肺損傷(RILT)的相關性,篩選敏感度、特異度、準確性較高的f-DVH預測因子及其參攷閾值.方法 行PET/CT/SPECT融閤影像引導胸部精確放療的Ⅲ期非小細胞肺癌(NSCLC)患者51例,在Philips Pinnacle3治療計劃繫統勾畫腫瘤靶區和週圍危及器官,製定三維適形或凋彊放療計劃.採用NCI CTC3.0標準對RILT進行分級.分析雙側肺、同側肺以及功能肺DVH參數與RILT的相關性,篩選預測RILT的最佳參數及其閾值.結果 中位隨訪15箇月,有10例(19.6%)髮生≥2級RILT.單因素分析雙側肺V5～V40,同側肺V5～V20,功能肺V5～V50與≥2級RILT髮生有關,多因素分析顯示雙側肺V15、功能肺V20與RILT相關(P=0.005,0.016).ROC麯線分析顯示功能肺V10(45.38%)預測敏感度最高,為90%;功能肺V25(27.78%)預測特異度最高,為90.24%;功能肺V20(29.61%)預測的敏感度、特異度、準確性分彆達到70.00%、73.17%、74.90%.結論 RILT髮生與功能肺的多箇f-DVH參數相關,併且f-DVH對RILT具有較好的預測敏感度和特異度.
목적 탐토공능폐제량체적직방도(f-DVH)삼수여후정가속초분할방료유도적방사성폐손상(RILT)적상관성,사선민감도、특이도、준학성교고적f-DVH예측인자급기삼고역치.방법 행PET/CT/SPECT융합영상인도흉부정학방료적Ⅲ기비소세포폐암(NSCLC)환자51례,재Philips Pinnacle3치료계화계통구화종류파구화주위위급기관,제정삼유괄형혹조강방료계화.채용NCI CTC3.0표준대RILT진행분급.분석쌍측폐、동측폐이급공능폐DVH삼수여RILT적상관성,사선예측RILT적최가삼수급기역치.결과 중위수방15개월,유10례(19.6%)발생≥2급RILT.단인소분석쌍측폐V5～V40,동측폐V5～V20,공능폐V5～V50여≥2급RILT발생유관,다인소분석현시쌍측폐V15、공능폐V20여RILT상관(P=0.005,0.016).ROC곡선분석현시공능폐V10(45.38%)예측민감도최고,위90%;공능폐V25(27.78%)예측특이도최고,위90.24%;공능폐V20(29.61%)예측적민감도、특이도、준학성분별체도70.00%、73.17%、74.90%.결론 RILT발생여공능폐적다개f-DVH삼수상관,병차f-DVH대RILT구유교호적예측민감도화특이도.
Objective To investigate the correlation between functional lung dose-volume histogram (f-DVH) parameters and radiation-induced lung toxicity (RILT) in patients of locally advanced non-small cell lung cancer (NSCLC) treated with late-course accelerated hyperfractionated radiotherapy and chemotherapy,and to identify the excellent predictors of f-DVH and their reference thresholds.Methods A total of 51 patients of NSCLC at stage Ⅲ underwent PET/CT/SPECT coregistered image guided radiotherapy.Philips Pinnacle3 planning system was used for delineation of the target volume and organs at risk so as to establish the three dimensional conformal radiotherapy or intensity-modulated radiotherapy treatment plans.The version 3.0 of the NCI Common Terminology Criteria for Adverse Events was used to evaluate the grade of RILT,and analyze the correlation of the DVH parameters of the total lung (TL),ipsilateral lung (IL),and functional lung (FL) and RILT,and to identify the excellent predictors.The median follow-up was 15 months.Results During the follow-up,10 cases of RILT (19.6%) ≥grade 2 were observed.Single factor analysis showed that the V5-V40 of TL,V5-V/20 of IL,and V5-V50 of FL were all related to the occurrence of RILT,and multiple factor analysis showed that TL-V15 and FL-V20remained associated with RILT (P = 0.005 and P = 0.016).According to ROC analysis,the V10 (45.38%) of FL was the most sensitive predictor with a sensitivity rate of 90.0% and 1/25 (27.78%) of FL was the most specific predictor with a specificity rate of 90.24%.The sensitivity,specificity and accuracy of V20 of FL were 70.00%,73.17%,and 74.90%,respectively.Conclusions The occurrence of RILT is closely associated with multiple f-DVH parameters of FL,and f-DVH has good sensitivity and specificity for prediction.
