CAJ | 학술논문

目的探讨不同定义的肺剂量体积直方图（DVH）参数与非小细胞肺癌（NSCLC）放射性肺炎（ RP）的相关性。方法入组三维适形调强放射治疗的NSCLC患者67例。在三维放疗计划系统中勾画每一位患者的双侧肺（BV）、患侧肺（IV）、健侧肺（CV）和功能肺（FV），分别作为计划评估的独立危及器官。依据DVH曲线，回顾性分析BV、IV、CV和FV接受5～60 Gy的相对肺体积（记为Vx，x＝5，10，15?60）与≥2级RP（CTCAE 3.0）的相关性。结果 BV5～30、IV5～15、CV5～20和FV5～20在RP组和No-RP组之间有统计学差异（P＜0.05），单因素分析上述参数均与RP的发生风险相关（P＜0.05），且各参数间存在显著共线性。受试者工作特征曲线证实BV5～25、IV5～15、CV5～20和FV5～20能够预测RP的发生风险，其曲线下面积范围相应分别为0.70～0.84、0.74～0.77、0.70～0.81和0.74～0.82。结论不同定义的肺DVH曲线前半部分参数均与≥2级RP的发生风险相关，各参数预测RP的ROC曲线下面积相近，约0.7～0.8。
목적탐토불동정의적폐제량체적직방도（DVH）삼수여비소세포폐암（NSCLC）방사성폐염（ RP）적상관성。방법입조삼유괄형조강방사치료적NSCLC환자67례。재삼유방료계화계통중구화매일위환자적쌍측폐（BV）、환측폐（IV）、건측폐（CV）화공능폐（FV），분별작위계화평고적독립위급기관。의거DVH곡선，회고성분석BV、IV、CV화FV접수5～60 Gy적상대폐체적（기위Vx，x＝5，10，15?60）여≥2급RP（CTCAE 3.0）적상관성。결과 BV5～30、IV5～15、CV5～20화FV5～20재RP조화No-RP조지간유통계학차이（P＜0.05），단인소분석상술삼수균여RP적발생풍험상관（P＜0.05），차각삼수간존재현저공선성。수시자공작특정곡선증실BV5～25、IV5～15、CV5～20화FV5～20능구예측RP적발생풍험，기곡선하면적범위상응분별위0.70～0.84、0.74～0.77、0.70～0.81화0.74～0.82。결론불동정의적폐DVH곡선전반부분삼수균여≥2급RP적발생풍험상관，각삼수예측RP적ROC곡선하면적상근，약0.7～0.8。
Objective To investigate the relationship between radiation pneumonitis ( RP) and dose-volume histogram(DVH)parameters of lung in non-small cell lung cancer(NSCLC)patients.Methods A total of 67 cases of NSCLC patients undergoing three dimensional conformal and intensity-modulated radiotherapy were recruited . Normal lung volumes of each patient were contoured at treatment planning system containing bilateral lung ( BV ) , ipsilateral lung(IV),contralateral lung(CV),and functional lung(FV).DVH parameters of BV,IV,CV,and FV (relative lung volume received 5-60 Gy at increment of 5 Gy)were correlated to grade 2 or worse RP(CTCAE 3.0) retrospectively.Results BV5-30 , IV5-15 , CV5-20 , and FV5-20 were signi cantly different between patients with and without RP,and significant association with the risk of RP (all values of P<0.05),however,colinearity was found between a serial of DVH parameters.Receiver operator characteristic (ROC)confirmed BV5-25,IV5-15,CV5-20,and FV5-20 were potential predictors for RP,the areas under the ROC curve were 0.70-0.84,0.74-0.77,0.70-0.81,and 0.74-0.82 ,respectively .Conclusions Diverse parameters from the first half part of DVH curves were correlations to the risk of RP,and the predictive areas under ROC curve were similar ,approximately 0.7-0.8.