中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2009年
6期
439-442
,共4页
付和谊%卢冰%徐冰清%胡银祥%甘家应%欧阳伟炜%苏胜发%王刚%栗蕙芹
付和誼%盧冰%徐冰清%鬍銀祥%甘傢應%歐暘偉煒%囌勝髮%王剛%慄蕙芹
부화의%로빙%서빙청%호은상%감가응%구양위위%소성발%왕강%률혜근
癌%非小细胞肺癌/放射疗法%放射疗法%后程加速超分割%放射疗法%三维适形%剂量体积直方图%放射性肺损伤
癌%非小細胞肺癌/放射療法%放射療法%後程加速超分割%放射療法%三維適形%劑量體積直方圖%放射性肺損傷
암%비소세포폐암/방사요법%방사요법%후정가속초분할%방사요법%삼유괄형%제량체적직방도%방사성폐손상
Carcinoma,non-smaU cell lung/radiotherapy%Radiotherapy,late-course accelerated hyperfraction%Radiotherapy,three-dimensional conformal%Dose volume histogram%Radiation-induced lung injury
目的 探讨非小细胞肺癌三维适形放疗正常肺低剂量体积对放射性肺损伤的预测作用.方法 采用三维适形后程加速超分割放疗经病理或细胞学证实的非小细胞肺癌患者100例.Ⅲ期14例,Ⅲb期36例,Ⅳ期50例.鳞癌49例,腺癌48例,腺鳞癌3例.初治79例、术后复发8例,术后残留12例,术后辅助1例.单纯放疗9例,放化疗91例.放疗剂量60～80 Gy,60～69 Gy 24例,≥70 Gy76例.化疗方案采用紫杉类+铂类一线方案.用剂量体积直方图计算正常肺V_5、V_(10)、V_(20)、V_(30)和平均肺剂量(MLD).肺损伤评估根据CTC 3.0标准.结果 全组V_5为37%～98%,中位值65%;V_(10)为27%～78%,中位值47.5%;V_(20)为17%～54%,中位值31%;V_(30)为9%～31%,中位值24%.100例患者中发生放射性肺炎(RP)1级34例,2级27例,3级8例,4级1例,5级1例.75例患者中发生放射性肺纤维化1级46例,2级14例,3级2例.V_5、V_(10)、V_(20)、MLD与≥1级RP相关,V_(5)、V_(20)、V_(30)、MLD与≥2级RP相关,V_5与≥3级RP相关.V_(5)、V_(20)、V_(30)、分别>65%、31%、24%时发生≥2级RP概率增加,V_(5)、V_(20)分别>65%、31%时发生≥3级RP概率增加,V_(20)>31%时发生≥1级RP概率增加.大体肿瘤体积、计划靶体积与≥1级RP、≥2级放射性肺纤维化相关.性别、年龄、临床分期、处方剂量、照射野数目与各级放射性肺损伤无关.结论 剂量体积参数V_(5)、V_(10)与RP发生相关,可能成为放射肺损伤有效的预测因子.
目的 探討非小細胞肺癌三維適形放療正常肺低劑量體積對放射性肺損傷的預測作用.方法 採用三維適形後程加速超分割放療經病理或細胞學證實的非小細胞肺癌患者100例.Ⅲ期14例,Ⅲb期36例,Ⅳ期50例.鱗癌49例,腺癌48例,腺鱗癌3例.初治79例、術後複髮8例,術後殘留12例,術後輔助1例.單純放療9例,放化療91例.放療劑量60～80 Gy,60～69 Gy 24例,≥70 Gy76例.化療方案採用紫杉類+鉑類一線方案.用劑量體積直方圖計算正常肺V_5、V_(10)、V_(20)、V_(30)和平均肺劑量(MLD).肺損傷評估根據CTC 3.0標準.結果 全組V_5為37%～98%,中位值65%;V_(10)為27%～78%,中位值47.5%;V_(20)為17%～54%,中位值31%;V_(30)為9%～31%,中位值24%.100例患者中髮生放射性肺炎(RP)1級34例,2級27例,3級8例,4級1例,5級1例.75例患者中髮生放射性肺纖維化1級46例,2級14例,3級2例.V_5、V_(10)、V_(20)、MLD與≥1級RP相關,V_(5)、V_(20)、V_(30)、MLD與≥2級RP相關,V_5與≥3級RP相關.V_(5)、V_(20)、V_(30)、分彆>65%、31%、24%時髮生≥2級RP概率增加,V_(5)、V_(20)分彆>65%、31%時髮生≥3級RP概率增加,V_(20)>31%時髮生≥1級RP概率增加.大體腫瘤體積、計劃靶體積與≥1級RP、≥2級放射性肺纖維化相關.性彆、年齡、臨床分期、處方劑量、照射野數目與各級放射性肺損傷無關.結論 劑量體積參數V_(5)、V_(10)與RP髮生相關,可能成為放射肺損傷有效的預測因子.
목적 탐토비소세포폐암삼유괄형방료정상폐저제량체적대방사성폐손상적예측작용.방법 채용삼유괄형후정가속초분할방료경병리혹세포학증실적비소세포폐암환자100례.Ⅲ기14례,Ⅲb기36례,Ⅳ기50례.린암49례,선암48례,선린암3례.초치79례、술후복발8례,술후잔류12례,술후보조1례.단순방료9례,방화료91례.방료제량60～80 Gy,60～69 Gy 24례,≥70 Gy76례.화료방안채용자삼류+박류일선방안.용제량체적직방도계산정상폐V_5、V_(10)、V_(20)、V_(30)화평균폐제량(MLD).폐손상평고근거CTC 3.0표준.결과 전조V_5위37%～98%,중위치65%;V_(10)위27%～78%,중위치47.5%;V_(20)위17%～54%,중위치31%;V_(30)위9%～31%,중위치24%.100례환자중발생방사성폐염(RP)1급34례,2급27례,3급8례,4급1례,5급1례.75례환자중발생방사성폐섬유화1급46례,2급14례,3급2례.V_5、V_(10)、V_(20)、MLD여≥1급RP상관,V_(5)、V_(20)、V_(30)、MLD여≥2급RP상관,V_5여≥3급RP상관.V_(5)、V_(20)、V_(30)、분별>65%、31%、24%시발생≥2급RP개솔증가,V_(5)、V_(20)분별>65%、31%시발생≥3급RP개솔증가,V_(20)>31%시발생≥1급RP개솔증가.대체종류체적、계화파체적여≥1급RP、≥2급방사성폐섬유화상관.성별、년령、림상분기、처방제량、조사야수목여각급방사성폐손상무관.결론 제량체적삼수V_(5)、V_(10)여RP발생상관,가능성위방사폐손상유효적예측인자.
Objective To analyze the low dose-volume associated with radiation-induced lung injury (RILI) in patients with advanced non-small cell lung cancer (NSCLC) treated by three-dimensional confor-real radiation therapy (3DCRT). Methods Data of 100 patients with histologically proved NSCLC treated with 3DCRT or IMRT between November 2006 and January 2009 were collected. Nine patients treated with radiotherapy alone and 91 with radiotherapy combined with chemotherapy. A median dose of 70 Gy (range,60-80 Gy) was delivered with late-course accelerated hyperfractionated radiotherapy (LAHRT). Twenty-four patients received dose of 61-69 Gy and 76 received more than 70 Gy. The V_5 ,V_(10) ,V_(20) ,V_(30)and mean lung dose (MLD) were calculated from the dose volume histogram system. The RILI was evaluated according to Common Toxicity Criteria 3.0(CTC 3.0). Results The range of V_5 ,V_(10) ,V_(20) ,V_(30) was 37%-98%,27%-78%, 17%-54% and 9%-31%, respectively, with a median value of 65%, 47.5%, 31% and 24%, respectively. The acute RILI of grade 1, 2, 3, 4 and 5 was observed in 34, 27, 8, 1 and 1 patients,respectively. The chronic RILI of grade 1, 2 and 3 was observed in 46, 14 and 2 patients, respectively. V_5 ,V_(10) ,V_(20) and MLD were significantly correlated with acute RILI of ≥ grade 1. V_5 ,V_(20) ,V_(30) and MLD were significantly correlated with acute RILI of ≥ grade 2. The acute RILI of ≥ grade 2 was significantly in-creased when V_5, V_(20) and V_(30) were more than 65%, 31% and 24%, respectively. The acute RILI of ≥ grade 3 was significantly increased when V_5 was more than 65%. The acute RILI of ≥ grade 1 was signifi-candy increased when V_(20)was more than 31%. The gross tumor volume and planning target volume were sig-nificantly correlated with the acute RILI of ≥ grade 1 and chronic RILI of ≥ grade 2. Conclusions The dose-volume V_5 and V_(10) are effective in predicting RILI.
