Rodrigues George, Lock Michael, D'Souza David, Yu Edward, Van Dyk Jake
Department of Radiation Oncology, London Regional Cancer Centre, London, Ontario, Canada.
Radiother Oncol. 2004 May;71(2):127-38. doi: 10.1016/j.radonc.2004.02.015.
To perform a systematic review of the predictive ability of various dose-volume histogram (DVH) parameters (V(dose), mean lung dose (MLD), and normal tissue complication probability (NTCP)) in the incidence of radiation pneumonitis (RP) caused by external-beam radiation therapy.
Studies assessing the relationship between CT-based DVH reduction parameters and RP rate in radically treated lung cancer were eligible for the review. Synonyms for RP, lung cancer, DVH and its associated parameters (NTCP, V(20), V(30), MLD) were combined in a search strategy involving electronic databases, secondary reference searching, and consultation with experts. Individual or group data were abstracted from the various reports to calculate operating characteristics and odds ratios for the different DVH metrics.
A total of 12 published studies and two abstracts were identified. Eleven studies assessed V(dose), seven assessed MLD, and eight assessed NTCP. Nine studies exclusively analyzed the association between various DVH metrics and RP risk. Five studies also analyzed other patient, tumor, and treatment variables in conjunction with standard DVH metrics. A direct comparison between studies and the generation of summary statistics (i.e. meta-analysis) could not be achieved due to significant predictive and outcome variable heterogeneity. Most studies did show an association between DVH parameters and RP risk. However, overall accuracy, sensitivity, specificity, and positive predictive value were generally poor to fair for all three classes of DVH metrics.
An association between DVH parameters and RP risk has been demonstrated in the literature. However, the ideal DVH metric with excellent operating characteristics, either alone or in a model with other predictive variables, for RP risk prediction has not yet been identified. Several recommendations for reporting and conduct of future research into the association between DVH metrics and RP risk are provided.
对外照射放疗所致放射性肺炎（RP）发生率中各种剂量体积直方图（DVH）参数（V（剂量）、平均肺剂量（MLD）和正常组织并发症概率（NTCP））的预测能力进行系统评价。
评估基于CT的DVH降低参数与根治性治疗肺癌中RP发生率之间关系的研究符合本综述要求。在涉及电子数据库、二次参考文献检索和专家咨询的检索策略中，将RP、肺癌、DVH及其相关参数（NTCP、V（20）、V（30）、MLD）的同义词进行组合。从各种报告中提取个体或组数据，以计算不同DVH指标的操作特征和比值比。
共鉴定出12项已发表研究和2篇摘要。11项研究评估了V（剂量），7项评估了MLD，8项评估了NTCP。9项研究专门分析了各种DVH指标与RP风险之间的关联。5项研究还结合标准DVH指标分析了其他患者、肿瘤和治疗变量。由于显著的预测和结果变量异质性，无法在研究之间进行直接比较并生成汇总统计数据（即荟萃分析）。大多数研究确实显示了DVH参数与RP风险之间的关联。然而，对于所有三类DVH指标，总体准确性、敏感性、特异性和阳性预测值通常较差至中等。
文献中已证明DVH参数与RP风险之间存在关联。然而，尚未确定具有优异操作特征的理想DVH指标，无论是单独使用还是与其他预测变量一起用于RP风险预测。提供了一些关于报告和开展未来DVH指标与RP风险关联研究的建议。
