CAJ | 학술논문

目的观察胸部肿瘤三维适形放疗患者放射性肺炎发生情况,分析其与各临床、剂量学因素关系,探讨低剂量区体积对放射性肺炎的预测价值.方法 2005-2008年本科收治的中晚期非小细胞肺癌(NSCLC)及食管癌患者共161例接受了三维适形放疗,其中局部晚期NSCLC患者53例,处方剂量60 Gy分30～34次,均行长春瑞滨+顺铂同期化疗;食管癌患者108例,处方剂量58～70 Gy分29～35次,单纯放疗46例,余62例接受亚叶酸钙+氟尿嘧啶+顺铂同期化疗.对急性放射性肺炎进行Spearman等级相关分析、Logistic因素分析及受试者工作特征(ROC)曲线分析.结果随访率100%.全组急性放射性肺炎总发生率为57.8%(93例),其中NSCLC组为94%(50例,4、5级各1例),食管癌组为39.8%(43例,无≥4级病例).等级相关分析结果显示患者性别(r=0.19,P=0.016)、大体肿瘤体积(r=0.52,P=0.000))、平均肺剂量(r=0.33,P=0.000)、肺正常组织并发症概率(r=0.30,P=0.000)、接受5、10、15、20、25、30 Gy照射的肺体积百分比(肺V5～V30,r=0.21～0.29,P=0.000～0.027)均与放射性肺炎发生相关.Logistic因素分析结果显示肺V5(X2=7.07,P=0.008)、大体肿瘤体积(X2=10.21,P=0.001)是预测≥2级放射性肺炎最有价值指标.ROC曲线分析结果显示曲线下面积为0.684,P=0.000;曲线界值为V5=55%.肺V5≥55%组与<55%组≥2级放射性肺炎发生率分别为43%(36/84)和18%(14/77).结论平均肺剂量、正常组织并发症概率、V5～V30可较好预测放射性肺炎的发生,其中V5可能是最有价值的预测性指标.当V5>55%时≥2级的急性放射性肺炎的发生率可能会明显增加,制定治疗计划时除平均肺剂量、V20、V30外,还应将低剂量区体积限制在适当范围内.
목적 관찰흉부종류삼유괄형방료환자방사성폐염발생정황,분석기여각림상、제량학인소관계,탐토저제량구체적대방사성폐염적예측개치.방법 2005-2008년본과수치적중만기비소세포폐암(NSCLC)급식관암환자공161례접수료삼유괄형방료,기중국부만기NSCLC환자53례,처방제량60 Gy분30～34차,균행장춘서빈+순박동기화료;식관암환자108례,처방제량58～70 Gy분29～35차,단순방료46례,여62례접수아협산개+불뇨밀정+순박동기화료.대급성방사성폐염진행Spearman등급상관분석、Logistic인소분석급수시자공작특정(ROC)곡선분석.결과 수방솔100%.전조급성방사성폐염총발생솔위57.8%(93례),기중NSCLC조위94%(50례,4、5급각1례),식관암조위39.8%(43례,무≥4급병례).등급상관분석결과현시환자성별(r=0.19,P=0.016)、대체종류체적(r=0.52,P=0.000))、평균폐제량(r=0.33,P=0.000)、폐정상조직병발증개솔(r=0.30,P=0.000)、접수5、10、15、20、25、30 Gy조사적폐체적백분비(폐V5～V30,r=0.21～0.29,P=0.000～0.027)균여방사성폐염발생상관.Logistic인소분석결과현시폐V5(X2=7.07,P=0.008)、대체종류체적(X2=10.21,P=0.001)시예측≥2급방사성폐염최유개치지표.ROC곡선분석결과현시곡선하면적위0.684,P=0.000;곡선계치위V5=55%.폐V5≥55%조여<55%조≥2급방사성폐염발생솔분별위43%(36/84)화18%(14/77).결론 평균폐제량、정상조직병발증개솔、V5～V30가교호예측방사성폐염적발생,기중V5가능시최유개치적예측성지표.당V5>55%시≥2급적급성방사성폐염적발생솔가능회명현증가,제정치료계화시제평균폐제량、V20、V30외,환응장저제량구체적한제재괄당범위내.
Objective To observe the incidence of radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC) or esophageal carcinoma treated by three-dimensional conformal radiation therapy (3DCRT), and investigate the predictive value of low dose volume of the lung on RP.Methods From Mar 2005 to Aug 2008, 161 patients with locally advanced NSCLC or esophageal carcinoma received 3DCRT. Fifty-three patients with NSCLC received radiotherapy of 60 Gy/30 -34 fx and concurrent chemotherapy of navelbine plus cisplatin (NP). Among the 108 patients with esophageal carcinoma with prescription doses ranging from 58 Gy/29 fx to 70 Gy/35 fx, 46 and 62 received 3DCRT alone or 3DCRT with concurrent chemotherapy of calcium folinate, 5-Fu and cisplatin (LFP), respectively. Univariate and multivariate analysis and receiver operating characteristics (ROC) curves were performed to assess the correlated factors of RP. Results The follow-up rate was 100%. The rate of RP was 57. 8% (93/161) for all patients, 94% (50/53,including 1 with Grade 4 and 1 with Grade 5) for patients with NSCLC, and 39.8% (43/108, none with Grade 4 and 5) for patients with esophageal carcinoma. The correlative factors included the sex, volume of gross tumor volume (GTV), mean lung dose (MLD), V5, V10, V15, V20, V25 and V30 of normal lung according to Spearman correlative analysis. Univariate analysis showed that all the 9 factors could predict RP. Only V5 and the volume of GTV were found independently associated with Grade 2 or more RP in multivariate analysis. ROC analysis indicated that the cut-off point of the curve was 55% with the area under ROC curve of 0. 684 (P = 0. 000). For the patients with lung V5 ≥ 55% and < 55% ,43% (36/84) and 18% (14/77) developed RP of Grade 2 or more, respectively. Conclusions Dosimetric parameters including MLD, normal tissue complication probability, and V5-V30 could predict RP. V5 may be the most valuable predictor. When V5 exceeds 55%, the probability of RP of grade 2 or more may increase notably. Besides the limitation of MLD, V20 and V30, the volume of low dose region should be also limited to a lower range during treatment planning.