CAJ | 학술논문

目的探讨剂量体积直方图(DVH)参数与非小细胞肺癌(NSCLC)三维适形放疗(3D-CRT)后放射性肺损伤CT分级的关系.方法将3D-CRT治疗后CT随访6个月以上的169例Ⅰ～Ⅲ期NSCLC患者,按随访CT放射性肺损伤的表现分级(0～4级),并分为CT阳性组(2～4级)和CT阴性组(0～1级).从放疗计划中获取患者的DVH参数,分析DVH参数与放射性肺损伤CT分级的关系,评价DVH参数对放射性肺损伤的预测价值.结果不同CT分级的全肺及患侧肺正常组织并发症概率(NTCP)值差异有统计学意义,随着CT分级的增加,NTCP相应增大.不同CT分级的全肺及患侧肺平均肺受照剂量(MLD)差异有统计学意义,随着CT分级的增加,全肺及患侧肺MLD相应增大.不同CT分级的全肺及患侧肺V20、V30和V40差异均有统计学意义,随着CT分级的增加,全肺及患侧肺V20、V30、V40相应增大.不同CT分级患者健侧肺的DVH参数差异无统计学意义.全肺、患侧肺DVH参数与患侧肺CT分级联系紧密,其中患侧肺NTCP与CT分级关联度最强(η=0.522).结论 NTCP、MID、V20、V30、V40等DVH参数与NSCLC 3D-CRT后放射性肺损伤的CT分级密切相关,可以作为评价及优化放疗计划的指标,以减少放疗后放射性肺损伤的发生.
목적 탐토제량체적직방도(DVH)삼수여비소세포폐암(NSCLC)삼유괄형방료(3D-CRT)후방사성폐손상CT분급적관계.방법 장3D-CRT치료후CT수방6개월이상적169례Ⅰ～Ⅲ기NSCLC환자,안수방CT방사성폐손상적표현분급(0～4급),병분위CT양성조(2～4급)화CT음성조(0～1급).종방료계화중획취환자적DVH삼수,분석DVH삼수여방사성폐손상CT분급적관계,평개DVH삼수대방사성폐손상적예측개치.결과 불동CT분급적전폐급환측폐정상조직병발증개솔(NTCP)치차이유통계학의의,수착CT분급적증가,NTCP상응증대.불동CT분급적전폐급환측폐평균폐수조제량(MLD)차이유통계학의의,수착CT분급적증가,전폐급환측폐MLD상응증대.불동CT분급적전폐급환측폐V20、V30화V40차이균유통계학의의,수착CT분급적증가,전폐급환측폐V20、V30、V40상응증대.불동CT분급환자건측폐적DVH삼수차이무통계학의의.전폐、환측폐DVH삼수여환측폐CT분급련계긴밀,기중환측폐NTCP여CT분급관련도최강(η=0.522).결론 NTCP、MID、V20、V30、V40등DVH삼수여NSCLC 3D-CRT후방사성폐손상적CT분급밀절상관,가이작위평개급우화방료계화적지표,이감소방료후방사성폐손상적발생.
Objective To explore the relationship of doze-volume histogram (DVH) parameters and computed tomography grading of radiation-induced lung injury in patients with non-small cell lung cancer (NSCLC) treated by three-dimensional conformal radiotherapy (3D-CRT). Methods One hundred sixtynine patients with stage Ⅰ～Ⅲ NSCLC, treated by 3D-CRT and followed by CT scan for more than six months after 3D-CRT, were divided into grade 0 to grade 4 based on the appearance of radiation-induced lung injury on CT image defined jointly by radiotherapist and radiologist. The patients were divided into CT positive group ( grade 2 to grade 4) and CT negative group ( grade 0 to grade 1 ), then the treatment planning shown to the patients were reviewed to compare and analyze the relationship of CT grading of radiation-induced lung injury and the DVH parameter selected. Results Regardless of whole lung or tumor-bearing lung, there was a statistically significant difference in normal tissue complication probability (NTCP) between the patients grouped with different CT grading of radiation-induced lung injury, and the mean of NTCP increased along with upgrade of CT grading. There was a statistically significant difference of mean lung dose (MLD) regardless of whole lung or tumor-bearing lung between the patients grouped with different CT grading of radiation-induced lung injury, and MLD increased along with upgrade of CT grading. There was a statistically significant difference of the volume received equal or more than 20 Gy ( V20 ), 30 Gy ( V30 ), 40 Gy (V40) of whole lung and tumor-bearing lung between the patients grouped with different CT grading of radiation-induced lung injury, and V20, V30, V40 increased along with upgrade of CT grading. There were not statistically significant differences of the DVH parameters of the contralateral lung in the patients of different groups based on the CT grading. On statistical analysis, the DVH parameters of whole lung and tumor-bearing lung closely correlated with CT grading of radiation-induced injury of the tumor-bearing lung, and there was a relatively strongest relationship between NTCP and CT grading of the tumor-bearing lung (η=0.522). Conclusion DVH parameters such NTCP, MLD, V20, V30, and V20 are statistically correlated closely with CT grading of radiation-induced lung injury after radiotherapy for the patients with NSCLC treated by 3D-CRT. Therefore the parameters can be selected as the reference for evaluation after 3D-CRT for patients with NSCLC.