Department of Radiation Oncology, The First Affiliated Hospital of China Medical University, 110001, Shenyang, China.
J Cancer Res Clin Oncol. 2010 Aug;136(8):1169-78. doi: 10.1007/s00432-010-0764-4. Epub 2010 Feb 4.
To investigate the correlation among DVH (lung dose-volume histogram) parameters, clinical factors, and grade > or = 2 radiation pneumonitis (RP) in patients with locally advanced non-small-cell lung cancer (NSCLC) treated with three-dimensional conformal radiotherapy (3D-CRT), and the differences between patients treated with 3D-CRT alone or that combined with chemotherapy on RP.
As much as 93 patients of stage III NSCLC were treated with 3D-CRT, among which 36 were treated with chemotherapy after 3D-CRT, 57 received 3D-CRT treatment alone. The radiation dose was 62.5-65 Gy (BED = 68-72.7 Gy).
The morbidity of grade > or = 2 RP was 49.5%, of which grade 2 and grade 3 were 33.3 and 16.1%, respectively. The morbidity of RP in those patients treated with chemotherapy after radiotherapy was evidently higher than that of patients treated with radiotherapy alone (61.1 vs. 42.1%). According to the single factor analysis, V5-V50 and MLD of both the ipsilateral and the whole lung were all related to the occurrence of RP; comparing grade 3 with grade 2 within the same group, except V45, V50, TV20, TV30, and TMLD, other parameters also had their statistical significance (P < 0.01); comparing the non-chemotherapy-treated group with the chemotherapy-treated group, TV30 and TV35 had their statistical significance. According to logistic regression analysis; the occurrence of RP was evidently associated with the comprehensive value of DVH parameters, chemotherapy, and gender. Chemotherapy has increased the risk of RP 7.6 times. The increase of each score in the comprehensive value of DVH parameters would increase the risk of RP 22.7 times.
The comprehensive values of DVH parameters, chemotherapy, and gender have independent effects on the occurrence of RP. Most of DVH parameters were associated with the occurrence of RP. The curve shape composed of multiple points in DVH parameters was more important than any single DVH parameter.
研究三维适形放疗（3D-CRT）治疗局部晚期非小细胞肺癌（NSCLC）患者的剂量-体积直方图（DVH）参数与临床因素及 2 级以上放射性肺炎（RP）的相关性，以及单纯 3D-CRT 治疗与联合化疗治疗对 RP 的影响。
93 例Ⅲ期 NSCLC 患者行 3D-CRT 治疗，其中 36 例在 3D-CRT 后行化疗，57 例单纯 3D-CRT 治疗。照射剂量为 62.5-65Gy（BED=68-72.7Gy）。
2 级以上 RP 的发病率为 49.5%，其中 2 级和 3 级分别为 33.3%和 16.1%。放疗后化疗患者的 RP 发病率明显高于单纯放疗患者（61.1%比 42.1%）。单因素分析显示，同侧及全肺 V5-V50、MLD 与 RP 发生相关；同一组内 3 级与 2 级比较，除 V45、V50、TV20、TV30、TMLD 外，其他参数也有统计学意义（P<0.01）；非化疗组与化疗组比较，TV30、TV35 有统计学意义。Logistic 回归分析显示，RP 的发生与 DVH 参数综合值、化疗、性别显著相关，化疗使 RP 发生的风险增加 7.6 倍，DVH 参数综合值每增加 1 分，RP 发生的风险增加 22.7 倍。
DVH 参数综合值、化疗、性别对 RP 的发生有独立影响，多数 DVH 参数与 RP 的发生相关，DVH 参数的曲线形态比任何单一参数都重要。
