中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2011年
1期
40-44
,共5页
王澜%吕冬婕%韩春%李晓宁%高超
王瀾%呂鼕婕%韓春%李曉寧%高超
왕란%려동첩%한춘%리효저%고초
肺肿瘤/放射疗法%食管肿瘤/放射疗法%放射疗法,三维适形%放射性肺炎%肺功能
肺腫瘤/放射療法%食管腫瘤/放射療法%放射療法,三維適形%放射性肺炎%肺功能
폐종류/방사요법%식관종류/방사요법%방사요법,삼유괄형%방사성폐염%폐공능
Lung neoplasms/radiotherapy%Esophagus neoplasms/radiotherapy%Radiotherapy,three-dimensional conformal%Radiation pneumonitis%Lung function
目的 观察食管癌及肺癌三维适形放疗患者急性放射性肺炎(ARP)发生情况,探讨基础肺功能及剂量体积直方图参数对中重度ARP的预测价值.方法 2006-2008年收治的中晚期非小细胞肺癌(NSCLC)及食管癌患者共64例接受同期放化疗,NSCLC患者23例,处方剂量60 Gy/30～34次,均行NP方案化疗;食管癌患者41例,处方剂量58～64 Gy/29～32次,均接受LFP方案化疗.对各因素进行Binary Logistic模型及受试者工作特征曲线分析.结果 全组ARP总发生率为56%;其中食管癌组为34%(以0、1级多见,占88%),NSCLC组为96%(以1、2级多见,占74%),两组比较差异有统计学意义(t=5.55,P=0.000).NSCLC组放疗前1 s率[1 s用力呼气量(FEV10)与用力肺活量(FVC)的百分比(FEV1.0/FVC)]、一氧化碳弥散量(DLCO)明显低于食管癌组,分别为75.6%:82.7%(t=2.75,P=0.008)、71.7%:81.0%(t=2.50,P=0.015);FEV10、FEV10/FVC、DLCO＜80%组和≥80%组放疗后≥2级ARP的发生率分别为35%和25%、31%和26%、35%和19%(x2=1.81、0.15、2.13,P=0.179、0.697、0.144),FEV1.0＜70%和≥70%组中重度ARP发生率分别为67%和22%(x2=5.64,P=0.018).相关性分析显示剂量学参数均与≥2级ARP的发生有关.多因素分析显示患者肺V20和平均肺剂量为最有价值预测指标(x2=4.61、6.97,P=0.032、0.008).结论 FEV1.0、FEV1.0/FVC和DLCO较低者接受放疗后中重度ARP的生风险相对偏高,但肺V20和平均肺剂量为最有价值预测指标.
目的 觀察食管癌及肺癌三維適形放療患者急性放射性肺炎(ARP)髮生情況,探討基礎肺功能及劑量體積直方圖參數對中重度ARP的預測價值.方法 2006-2008年收治的中晚期非小細胞肺癌(NSCLC)及食管癌患者共64例接受同期放化療,NSCLC患者23例,處方劑量60 Gy/30～34次,均行NP方案化療;食管癌患者41例,處方劑量58～64 Gy/29～32次,均接受LFP方案化療.對各因素進行Binary Logistic模型及受試者工作特徵麯線分析.結果 全組ARP總髮生率為56%;其中食管癌組為34%(以0、1級多見,佔88%),NSCLC組為96%(以1、2級多見,佔74%),兩組比較差異有統計學意義(t=5.55,P=0.000).NSCLC組放療前1 s率[1 s用力呼氣量(FEV10)與用力肺活量(FVC)的百分比(FEV1.0/FVC)]、一氧化碳瀰散量(DLCO)明顯低于食管癌組,分彆為75.6%:82.7%(t=2.75,P=0.008)、71.7%:81.0%(t=2.50,P=0.015);FEV10、FEV10/FVC、DLCO＜80%組和≥80%組放療後≥2級ARP的髮生率分彆為35%和25%、31%和26%、35%和19%(x2=1.81、0.15、2.13,P=0.179、0.697、0.144),FEV1.0＜70%和≥70%組中重度ARP髮生率分彆為67%和22%(x2=5.64,P=0.018).相關性分析顯示劑量學參數均與≥2級ARP的髮生有關.多因素分析顯示患者肺V20和平均肺劑量為最有價值預測指標(x2=4.61、6.97,P=0.032、0.008).結論 FEV1.0、FEV1.0/FVC和DLCO較低者接受放療後中重度ARP的生風險相對偏高,但肺V20和平均肺劑量為最有價值預測指標.
목적 관찰식관암급폐암삼유괄형방료환자급성방사성폐염(ARP)발생정황,탐토기출폐공능급제량체적직방도삼수대중중도ARP적예측개치.방법 2006-2008년수치적중만기비소세포폐암(NSCLC)급식관암환자공64례접수동기방화료,NSCLC환자23례,처방제량60 Gy/30～34차,균행NP방안화료;식관암환자41례,처방제량58～64 Gy/29～32차,균접수LFP방안화료.대각인소진행Binary Logistic모형급수시자공작특정곡선분석.결과 전조ARP총발생솔위56%;기중식관암조위34%(이0、1급다견,점88%),NSCLC조위96%(이1、2급다견,점74%),량조비교차이유통계학의의(t=5.55,P=0.000).NSCLC조방료전1 s솔[1 s용력호기량(FEV10)여용력폐활량(FVC)적백분비(FEV1.0/FVC)]、일양화탄미산량(DLCO)명현저우식관암조,분별위75.6%:82.7%(t=2.75,P=0.008)、71.7%:81.0%(t=2.50,P=0.015);FEV10、FEV10/FVC、DLCO＜80%조화≥80%조방료후≥2급ARP적발생솔분별위35%화25%、31%화26%、35%화19%(x2=1.81、0.15、2.13,P=0.179、0.697、0.144),FEV1.0＜70%화≥70%조중중도ARP발생솔분별위67%화22%(x2=5.64,P=0.018).상관성분석현시제량학삼수균여≥2급ARP적발생유관.다인소분석현시환자폐V20화평균폐제량위최유개치예측지표(x2=4.61、6.97,P=0.032、0.008).결론 FEV1.0、FEV1.0/FVC화DLCO교저자접수방료후중중도ARP적생풍험상대편고,단폐V20화평균폐제량위최유개치예측지표.
Objective To observe the incidence of RP in NSCLC and esophageal carcinoma treated with 3DCRT and investigate the relationship between acute RP and lung function and dosimetric parameters.Methods From October 2006 to August 2008, 3DCRT plus concurrent chemotherapy of NP or LFP were applied to 64 patients with locally advanced NSCLC or esophageal carcinoma. twenty-three patients suffered form NSCLC and 41 patients from esophageal carcinoma, the prescription doses were 60 Gy/30fx and 58 -64 Gy/29 -32fx, respectively. Results For patients with esophageal carcinoma, 34% developed RP(9 grade 1,3 grade 2 and 2 grade 3). For patients with NSCLC, 96% developed RP(9 grade 1, 8 grade 2 and 5 grade 3). There was significant difference between the two groups(t =5. 55,P=0. 000). The FEV1.0/FVC and DLCO of patients with NSCLC were significantly lower than those of esophageal carcinoma, the ratio were 75.6%:82.7%(t=2.75,P=0.008)and 71.7%:81.0%(t=2.50, P=0.015),respectively. For patients whose FEV1.0, FEV1.0/FVC%, DLCO ＜80% and ≥80% before irradiation,the incidence of ≥2grade ARP were 35% vs 25% ,31% vs 26% and 35% vs 19%, respectively(x2 = 1.81,0.15,2. 13,P =0.179,0.697,0.144). While for patients whose FEV1.0 ＜ 70% and ≥70%, the incidence of severe ARP were 67% and 22% ,respectively(x2 =5.64, P =0.018). Spearman correlated analysis indicated that all the dosimetric parameters had relation with ≥ 2 grade ARP . The V20 of lung and MLD were found independently associated with RP according to multivariate analysis(x2 = 4.61,6.97, P = 0.032,0.008).Conclusions Parameters of basic lung function can predict the incidence of ≥2 grade RP to some extent,especially when the value of FEV1.0, FEV1.0/FVC%, and DLCO was lower. However, the V20 of lung and MLD may be the most valuable predictors.
