Dehing-Oberije Cary, De Ruysscher Dirk, van Baardwijk Angela, Yu Shipeng, Rao Bharat, Lambin Philippe
Department of Radiotherapy, University Maastricht, GROW, Maastricht, The Netherlands.
Radiother Oncol. 2009 Jun;91(3):421-6. doi: 10.1016/j.radonc.2008.12.002. Epub 2009 Jan 13.
Extensive research has led to the identification of numerous dosimetric parameters as well as patient characteristics, associated with lung toxicity, but their clinical usefulness remains largely unknown. We investigated the predictive value of patient characteristics in combination with established dosimetric parameters.
Data from 438 lung cancer patients treated with (chemo)radiation were used. Lung toxicity was scored using the Common Toxicity Criteria version 3.0. A multivariate model as well as two single parameter models, including either V(20) or MLD, was built. Performance of the models was expressed as the AUC (Area Under the Curve).
The mean MLD was 13.5 Gy (SD 4.5 Gy), while the mean V(20) was 21.0% (SD 7.3%). Univariate models with V(20) or MLD both yielded an AUC of 0.47. The final multivariate model, which included WHO-performance status, smoking status, forced expiratory volume (FEV(1)), age and MLD, yielded an AUC of 0.62 (95% CI: 0.55-0.69).
Within the range of radiation doses used in our clinic, dosimetric parameters play a less important role than patient characteristics for the prediction of lung toxicity. Future research should focus more on patient-related factors, as opposed to dosimetric parameters, in order to identify patients at high risk for developing radiation-induced lung toxicity more accurately.
大量研究已确定了许多与肺部毒性相关的剂量学参数以及患者特征，但其临床实用性在很大程度上仍不明确。我们研究了患者特征与既定剂量学参数相结合的预测价值。
使用了438例接受（化疗）放疗的肺癌患者的数据。采用3.0版通用毒性标准对肺部毒性进行评分。构建了一个多变量模型以及两个单参数模型，其中单参数模型分别包含V(20)或平均肺剂量（MLD）。模型的性能以曲线下面积（AUC）表示。
平均MLD为13.5 Gy（标准差4.5 Gy），而平均V(20)为21.0%（标准差7.3%）。含V(20)或MLD的单变量模型的AUC均为0.47。最终的多变量模型纳入了世界卫生组织（WHO）的体能状态、吸烟状况、用力呼气量（FEV(1)）、年龄和MLD，其AUC为0.62（95%置信区间：0.55 - 0.69）。
在我们临床使用的放射剂量范围内，对于预测肺部毒性，剂量学参数的作用不如患者特征重要。未来的研究应更多地关注与患者相关的因素，而非剂量学参数，以便更准确地识别有发生放射性肺损伤高风险的患者。
