中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2010年
5期
420-424
,共5页
韩蕾%卢冰%付和谊%胡银祥%甘家应%徐冰清%王刚%梁娜%栗惠芹
韓蕾%盧冰%付和誼%鬍銀祥%甘傢應%徐冰清%王剛%樑娜%慄惠芹
한뢰%로빙%부화의%호은상%감가응%서빙청%왕강%량나%률혜근
癌,非小细胞肺/放射疗法%放射疗法,三维适形或调强%放射疗法,后程加速超分割%放射性肺炎%剂量体积直方图
癌,非小細胞肺/放射療法%放射療法,三維適形或調彊%放射療法,後程加速超分割%放射性肺炎%劑量體積直方圖
암,비소세포폐/방사요법%방사요법,삼유괄형혹조강%방사요법,후정가속초분할%방사성폐염%제량체적직방도
Carcinoma,non-small cell lung/radiotherapy%Radiotherapy,three-dimensional conformal or intensity-modulated%Radiotherapy,late-course accelerated hyperfraction%Radiation pneumonitis%Dose volume histogram
目的 探讨非小细胞肺癌三维适形或调强放疗正常肺V5和V10联合V20评价放射性肺炎(RP)的意义.方法 采用三维适形或调强后程加速超分割放疗经病理或细胞学证实初治非小细胞肺癌患者90例,其中Ⅲa期6例、Ⅲb期29例、Ⅳ期55例.放疗剂量61~80 Gy,中位数70 Gy.由剂量体积直方图计算全肺V5、V10、V20、V30、平均肺剂量(MLD),对侧肺V5、V10及同侧肺V30.用CTC3.0标准评估肺损伤.结果 90例患者中发生RP为1级29例、2级23例、3级5例、4级1例、5级1例.全肺V5、V10、V20、对侧肺V10、大体肿瘤体积(GTV)、计划靶体积、射野数目与≥1级RP相关(χ2=2.04、2.05、2.01、4.62、6.50、5.61、5.61,P=0.044、0.043、0.047、0.030、0.010、0.020、0.020),全肺V5、V10、V20和V30、MLD与≥2级RP相关(χ2=2.05、2.20、2.96、4.96、5.20,P=0.040、0.030、0.000、0.030、0.020).多因素分析显示GTV与≥1级RP发生相关(χ2=4.06,P=0.044),V20与≥2级RP发生相关(χ2=9.61,P=0.002).全肺V5、V10、V20的中位数分别为66%、48%、31%.V20>31%时≥2级RP概率增加,V20>31%+V10>48%+V5>66%时≥2级RP概率增加,V20>31%+V5>66%时≥2级RP概率增加;V20>31%时V10>48%与<48%比较RP概率相似,V20≤31%时V5>66%与<66%、V10>48%与<48%比较RP概率也相似.性别、年龄、临床分期、病理类型、治疗方式、KPS与≥1、2级RP无关.结论 肺V5、V10联合V20评价放射性肺炎的发生可能提高预测放射性肺炎的能力.
目的 探討非小細胞肺癌三維適形或調彊放療正常肺V5和V10聯閤V20評價放射性肺炎(RP)的意義.方法 採用三維適形或調彊後程加速超分割放療經病理或細胞學證實初治非小細胞肺癌患者90例,其中Ⅲa期6例、Ⅲb期29例、Ⅳ期55例.放療劑量61~80 Gy,中位數70 Gy.由劑量體積直方圖計算全肺V5、V10、V20、V30、平均肺劑量(MLD),對側肺V5、V10及同側肺V30.用CTC3.0標準評估肺損傷.結果 90例患者中髮生RP為1級29例、2級23例、3級5例、4級1例、5級1例.全肺V5、V10、V20、對側肺V10、大體腫瘤體積(GTV)、計劃靶體積、射野數目與≥1級RP相關(χ2=2.04、2.05、2.01、4.62、6.50、5.61、5.61,P=0.044、0.043、0.047、0.030、0.010、0.020、0.020),全肺V5、V10、V20和V30、MLD與≥2級RP相關(χ2=2.05、2.20、2.96、4.96、5.20,P=0.040、0.030、0.000、0.030、0.020).多因素分析顯示GTV與≥1級RP髮生相關(χ2=4.06,P=0.044),V20與≥2級RP髮生相關(χ2=9.61,P=0.002).全肺V5、V10、V20的中位數分彆為66%、48%、31%.V20>31%時≥2級RP概率增加,V20>31%+V10>48%+V5>66%時≥2級RP概率增加,V20>31%+V5>66%時≥2級RP概率增加;V20>31%時V10>48%與<48%比較RP概率相似,V20≤31%時V5>66%與<66%、V10>48%與<48%比較RP概率也相似.性彆、年齡、臨床分期、病理類型、治療方式、KPS與≥1、2級RP無關.結論 肺V5、V10聯閤V20評價放射性肺炎的髮生可能提高預測放射性肺炎的能力.
목적 탐토비소세포폐암삼유괄형혹조강방료정상폐V5화V10연합V20평개방사성폐염(RP)적의의.방법 채용삼유괄형혹조강후정가속초분할방료경병리혹세포학증실초치비소세포폐암환자90례,기중Ⅲa기6례、Ⅲb기29례、Ⅳ기55례.방료제량61~80 Gy,중위수70 Gy.유제량체적직방도계산전폐V5、V10、V20、V30、평균폐제량(MLD),대측폐V5、V10급동측폐V30.용CTC3.0표준평고폐손상.결과 90례환자중발생RP위1급29례、2급23례、3급5례、4급1례、5급1례.전폐V5、V10、V20、대측폐V10、대체종류체적(GTV)、계화파체적、사야수목여≥1급RP상관(χ2=2.04、2.05、2.01、4.62、6.50、5.61、5.61,P=0.044、0.043、0.047、0.030、0.010、0.020、0.020),전폐V5、V10、V20화V30、MLD여≥2급RP상관(χ2=2.05、2.20、2.96、4.96、5.20,P=0.040、0.030、0.000、0.030、0.020).다인소분석현시GTV여≥1급RP발생상관(χ2=4.06,P=0.044),V20여≥2급RP발생상관(χ2=9.61,P=0.002).전폐V5、V10、V20적중위수분별위66%、48%、31%.V20>31%시≥2급RP개솔증가,V20>31%+V10>48%+V5>66%시≥2급RP개솔증가,V20>31%+V5>66%시≥2급RP개솔증가;V20>31%시V10>48%여<48%비교RP개솔상사,V20≤31%시V5>66%여<66%、V10>48%여<48%비교RP개솔야상사.성별、년령、림상분기、병리류형、치료방식、KPS여≥1、2급RP무관.결론 폐V5、V10연합V20평개방사성폐염적발생가능제고예측방사성폐염적능력.
Objective To analyze relation of comprehensive parameters of the dose-volume V5,V10 and V20 with radiation pneumonitis (RP) in patients with advanced stage non-small-cell lung cancer (NSCLC) treated with three-dimensional conformal (3DCRT) or intensity-modulated radiation therapy (IMRT).Methods Data of 90 patients with histologically proved NSCLC treated with 3DCRT or IMRT between November 2006 and July 2009 were collected.The median radiation dose of 70 Gy (range, 61 - 80 Gy) was delivered with late-course accelerated hyperfractionated radiotherapy (LAHRT).The V5 ,V10 ,V20,V30 and mean lung dose (MLD) were calculated from the dose-volume histogram system.The RP was evaluated according to the common toxicity criteria 3.0(CTC 3.0).Results The range of V5 ,V10 and V20 was 36% - 98%, 27% - 78% and 19% - 54%, respectively, with a median value of 66%, 48% and 31%, respectively.The RP of grade 1,2,3,4 and 5 was observed in 29,23,5,1 and 1 patients.The V5,V10 ,V20, contralateral V10, GTV,PTV, and numbers of fields were all significantly associated with RP of ≥grade 1 (χ2=2.04, 2.05, 2.01, 4.62, 6.50, 5.61, 5.61, and P= 0.044, 0.043, 0.047, 0.030,0.010,0.020,0.020).The V5, V10, V20, V30, and MLD were all significantly associated with RP of ≥ grade 2 (χ2= 2.05,2.20,2.96,4.96,5.20, and P = 0.040,0.030,0.000,0.030,0.020).In Logistic regression analysis, GTV was the only factor significantly associated with RP of ≥ grade 1 (χ2= 4.06, P =0.044).The V20 was the only factor significantly associated with RP of ≥grade 2(χ2=9.61,P=0.002).The RP of ≥grade 2 was significantly increased when V20 was more than 31%.The RP of ≥grade 2 was significantly increased when V20, V10 and V5 were more than 31%, 48% and 66%, respectively.The RP of ≥ grade 2 was significantly increased when V20 was more than 31% and V5 was more than 66%.Conclusions The comprehensive parameters combined with V5, V10 and V20 are effective in predicting RP.