CAJ | 학술논문

目的探讨3DCRT计划中双肺-GTV、CTV、PTV三种定义下正常肺DVH参数差异及对RP的预测价值.方法对2006-2010年间行3DCRT的147例NSCLC患者分别定义双肺-GTV、CTV、PTV正常肺并收集相关DVH剂量学信息,比较参数值差异及其对RP的预测价值.剂量学参数间差异采用成组t检验,用ROC曲线分析各剂量学因素的预测价值.结果以MLD为例,双肺-GTV定义下与双肺-CTV、PTV的差值分别为(1.16±0.96)、(3.45 ±1.43) Gy.同一患者不同定义下MLD最大差值为8.73 Gy.双肺-GTV下MLD对≥2、3级RP预测价值优于双肺-CTV、PTV的,表现为ROC曲线下面积较大,分别为0.614和0.678、0.566和0.602、0.551和0.616(P=0.024和0.056、0.269和0.226、0.317和0.167).对肺V5-V50的分析也得出类似结论.结论基于不同定义下所得的剂量学参数存在较大差异,临床不能忽视;基于双肺-GTV所得相关剂量学参数对RP预测价值最佳,建议采用.
목적 탐토3DCRT계화중쌍폐-GTV、CTV、PTV삼충정의하정상폐DVH삼수차이급대RP적예측개치.방법 대2006-2010년간행3DCRT적147례NSCLC환자분별정의쌍폐-GTV、CTV、PTV정상폐병수집상관DVH제량학신식,비교삼수치차이급기대RP적예측개치.제량학삼수간차이채용성조t검험,용ROC곡선분석각제량학인소적예측개치.결과 이MLD위례,쌍폐-GTV정의하여쌍폐-CTV、PTV적차치분별위(1.16±0.96)、(3.45 ±1.43) Gy.동일환자불동정의하MLD최대차치위8.73 Gy.쌍폐-GTV하MLD대≥2、3급RP예측개치우우쌍폐-CTV、PTV적,표현위ROC곡선하면적교대,분별위0.614화0.678、0.566화0.602、0.551화0.616(P=0.024화0.056、0.269화0.226、0.317화0.167).대폐V5-V50적분석야득출유사결론.결론 기우불동정의하소득적제량학삼수존재교대차이,림상불능홀시;기우쌍폐-GTV소득상관제량학삼수대RP예측개치최가,건의채용.
Objective To compare lung dose-volume histogram (DVH) parameters based on commonly used normal lung definitions,i.e.,lungs-gross tumor volume (GTV),lungs-clinical target volume (CTV),and lungs-planning target volume (PTV),in three-dimensional conformal radiotherapy (3 DCRT) and to determine to what extent they differ in predicting radiation pneumonitis (RP).Methods A total of 147 non-small cell lung cancer patients treated with concurrent chemotherapy and 3DCRT from 2006 to 2010 were collected.RP was diagnosed according to RTOG criteria.Lung DVHs were generated with exclusion of GTV,CTV,or PTV.Independent-samples t test was used to compare DVH parameters based on different normal lung definitions,and the predictive values of these parameters for RP were evaluated with the receiver operating characteristic (ROC) curve.Results There were significant differences in minimum lethal dose (MLD) between lungs-GTV and lungs-CTV/lungs-PTV ((1.16 ± 0.96) Gy vs.(3.45 ± 1.43) Gy).The biggest difference in MLD for the same patient based on different definitions was 8.73 Gy.MLD based on lungs-GTV had a better predictive value for grades ≥2 and ≥3 RP than MLD based on lungs-CTV and lungs-PTV,with larger areas under the ROC curve (lungs-GTV ∶ area =0.614,P=0.024;area =0.678,P=0.056;lungs-CTV∶area =0.556,P=0.269;area =0.602,P=0.226 ; lungs-PTV ∶ area =0.551,P =0.317 ; area =0.616,P =0.167).We drew a similar conclusion when analyzing lung V5-V50.Conclusions There are significant differences between DVH parameters based on various normal lung definitions,which cannot be neglected in the clinical setting.DVH parameters based on lungs-GTV may be the most accurate in predicting RP.