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
4期
274-277
,共4页
姬巍%王绿化%欧广飞%梁军%冯勤付%陈东福%周宗玫%张红星%肖泽芬%殷蔚伯
姬巍%王綠化%歐廣飛%樑軍%馮勤付%陳東福%週宗玫%張紅星%肖澤芬%慇蔚伯
희외%왕녹화%구엄비%량군%풍근부%진동복%주종매%장홍성%초택분%은위백
肺肿瘤/放射疗法%放射疗法,三维适形%放射性肺炎
肺腫瘤/放射療法%放射療法,三維適形%放射性肺炎
폐종류/방사요법%방사요법,삼유괄형%방사성폐염
Lung neoplasms/radiotherapy%Radiotherapy,three-dimensional conformal%Radia-tion pneumonitis
目的 分析非小细胞肺癌(NSCLC)术后接受三维适形放疗(3DCRT)肺损伤的相关因素.方法 对2002年11月至2006年3月符合入组条件的90例患者进行回顾性分析,其中Ⅰ～Ⅱ期12例(切缘阳性),ⅢA期53例,ⅢB期25例.术后均接受了中位剂量60 Gy的3DCRT,38例接受了中位3周期术后化疗.观察指标为CTC 3.0 2级以上放射性肺炎(RP).应用ROC曲线分析健侧、患侧和双肺接受x Gy剂量的相对体积(Vx)和绝对体积与RP的关系.结果 全组共9例患者出现有症状的RP,RP发生率为10%.接受全肺切除的20例患者中无RP发生.RP中位发生时间在放疗开始后101 d,其中2级7例,3级2例.双肺V30、V35在RP组明显高于未发生RP组(19%∶14%,U=-2.16,P=0.030;15%:11%,U=-2.65,P=0.007).以患侧肺接受30 Gy照射的绝对体积作为分界点进行ROC曲线分析结果 显示曲线下面积为0.757,对RP预测的敏感性为88%、特异性为70%.患肺接受30 Gy照射的绝对体积>340 cm3的RP发生率明显高于体积<340 cm3的(29%∶3%,x2=9.75,P=0.003).结论 对于肺叶切除的NSCLC患者接受术后放疗,患肺接受30 Gy照射的绝对体积与RP相关.对全肺切除患者,单肺V20限制在10%以下,接受术后放疗是安全可行的.
目的 分析非小細胞肺癌(NSCLC)術後接受三維適形放療(3DCRT)肺損傷的相關因素.方法 對2002年11月至2006年3月符閤入組條件的90例患者進行迴顧性分析,其中Ⅰ～Ⅱ期12例(切緣暘性),ⅢA期53例,ⅢB期25例.術後均接受瞭中位劑量60 Gy的3DCRT,38例接受瞭中位3週期術後化療.觀察指標為CTC 3.0 2級以上放射性肺炎(RP).應用ROC麯線分析健側、患側和雙肺接受x Gy劑量的相對體積(Vx)和絕對體積與RP的關繫.結果 全組共9例患者齣現有癥狀的RP,RP髮生率為10%.接受全肺切除的20例患者中無RP髮生.RP中位髮生時間在放療開始後101 d,其中2級7例,3級2例.雙肺V30、V35在RP組明顯高于未髮生RP組(19%∶14%,U=-2.16,P=0.030;15%:11%,U=-2.65,P=0.007).以患側肺接受30 Gy照射的絕對體積作為分界點進行ROC麯線分析結果 顯示麯線下麵積為0.757,對RP預測的敏感性為88%、特異性為70%.患肺接受30 Gy照射的絕對體積>340 cm3的RP髮生率明顯高于體積<340 cm3的(29%∶3%,x2=9.75,P=0.003).結論 對于肺葉切除的NSCLC患者接受術後放療,患肺接受30 Gy照射的絕對體積與RP相關.對全肺切除患者,單肺V20限製在10%以下,接受術後放療是安全可行的.
목적 분석비소세포폐암(NSCLC)술후접수삼유괄형방료(3DCRT)폐손상적상관인소.방법 대2002년11월지2006년3월부합입조조건적90례환자진행회고성분석,기중Ⅰ～Ⅱ기12례(절연양성),ⅢA기53례,ⅢB기25례.술후균접수료중위제량60 Gy적3DCRT,38례접수료중위3주기술후화료.관찰지표위CTC 3.0 2급이상방사성폐염(RP).응용ROC곡선분석건측、환측화쌍폐접수x Gy제량적상대체적(Vx)화절대체적여RP적관계.결과 전조공9례환자출현유증상적RP,RP발생솔위10%.접수전폐절제적20례환자중무RP발생.RP중위발생시간재방료개시후101 d,기중2급7례,3급2례.쌍폐V30、V35재RP조명현고우미발생RP조(19%∶14%,U=-2.16,P=0.030;15%:11%,U=-2.65,P=0.007).이환측폐접수30 Gy조사적절대체적작위분계점진행ROC곡선분석결과 현시곡선하면적위0.757,대RP예측적민감성위88%、특이성위70%.환폐접수30 Gy조사적절대체적>340 cm3적RP발생솔명현고우체적<340 cm3적(29%∶3%,x2=9.75,P=0.003).결론 대우폐협절제적NSCLC환자접수술후방료,환폐접수30 Gy조사적절대체적여RP상관.대전폐절제환자,단폐V20한제재10%이하,접수술후방료시안전가행적.
Objective To evaluate the relation between lung dosimetric parameters and the risk of symptomatic radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC) who had re-ceived postoperative radiotherapy. Methods From November 2002 to March 2006, 90 patients with NSCLC who had received postoperative 3-dimentinal conformal radiotherapy (3DCRT) were retrospectively analyzed, including 53 with stage ⅢA disease, 25 with stafe ⅢB disease and 12 with stage Ⅰ-Ⅱ disease but positive margins. Seventy (78%) patients underwent lobectomy, 20 ( 22% ) underwent pneumonectomy, and 38 ( 46% ) received adjuvant chemotherapy. The median radiation dose was 60 Gy given in 30 fractions of 2 Gy using 6 MV X-ray. The percentage of the whole lung volume ( Vx ) and the ipsilateral absolute lung volume ( Vipsi-dosewhich received more than a certain dose were calculated. The endpoint was grade 2 and above RP based on CTC AE 3.0. The relation between the dosimetric factors and RP was also analyzed with receiver operating characteristic (ROC) curves. Results Nine patients ( 10% ) developed symptomatic RP ( grade 2 in 7 and grade 3 in 2), and all of them were in the lobectomy group. No RP was observed in patients who received pneumonectomy. Both V30 and V35 were higher in patients with RP than those without ( 19% vs 14% ,U= -2.16,P=0.030, and 15% vs 11%,U= -2.65,P =0.007, respectively). The area under curve in receiver operating characteristic curves based on the relation between incidence of RP and the value of Vipsi-dose was 0. 757. Using Vipsi-30 of 340 cm3 as a cut-off to predict RP, the sensitivity and specificity were 88% and 70%, respectively. The incidence of RP was 3% in patients with Vipsi-30< 340 cm3 compared with 29% in those with Vipsi-30>340cm3 ( X2 = 9.75 , P = 0.003 ) . Conclusions More than340 cm3 of the ipsilateral lung receiving 30 Gy is significantly related to the risk of RP in patients undergoing lobectomy. It is safe for patients who undergo pneumonectomy to receive postoperative 3DCRT if lung V20 is less than 10%.
