Department of Radiation Oncology, University of Michigan/Ann Arbor Veterans Health System, Ann Arbor, Michigan, USA.
Int J Radiat Oncol Biol Phys. 2013 Mar 1;85(3):798-804. doi: 10.1016/j.ijrobp.2012.06.040. Epub 2012 Jul 24.
Poor pulmonary function (PF) is often considered a contraindication to definitive radiation therapy for lung cancer. This study investigated whether baseline PF was associated with radiation-induced lung toxicity (RILT) in patients with non-small cell lung cancer (NSCLC) receiving conformal radiation therapy (CRT).
NSCLC patients treated with CRT and tested for PF at baseline were eligible. Baseline predicted values of forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), and diffusion capacity of lung for carbon monoxide (DLCO) were analyzed. Additional factors included age, gender, smoking status, Karnofsky performance status, coexisting chronic obstructive pulmonary disease (COPD), tumor location, histology, concurrent chemotherapy, radiation dose, and mean lung dose (MLD) were evaluated for RILT. The primary endpoint was symptomatic RILT (SRILT), including grade ≥2 radiation pneumonitis and fibrosis.
There was a total of 260 patients, and SRILT occurred in 58 (22.3%) of them. Mean FEV1 values for SRILT and non-SRILT patients were 71.7% and 65.9% (P=.077). Under univariate analysis, risk of SRILT increased with MLD (P=.008), the absence of COPD (P=.047), and FEV1 (P=.077). Age (65 split) and MLD were significantly associated with SRILT in multivariate analysis. The addition of FEV1 and age with the MLD-based model slightly improved the predictability of SRILT (area under curve from 0.63-0.70, P=.088).
Poor baseline PF does not increase the risk of SRILT, and combining FEV1, age, and MLD may improve the predictive ability.
通常认为肺部功能（PF）较差是肺癌根治性放疗的禁忌症。本研究旨在探讨接受适形放疗（CRT）的非小细胞肺癌（NSCLC）患者的基线 PF 是否与放射性肺毒性（RILT）相关。
符合条件的 NSCLC 患者需接受 CRT 治疗，并在基线时进行 PF 检测。分析了 1 秒用力呼气量（FEV1）、用力肺活量（FVC）和一氧化碳弥散量（DLCO）的预测值。其他因素包括年龄、性别、吸烟状况、卡氏功能状态、并存的慢性阻塞性肺疾病（COPD）、肿瘤位置、组织学、同期化疗、放疗剂量和平均肺剂量（MLD），以评估 RILT。主要终点是有症状的 RILT（SRILT），包括 2 级及以上放射性肺炎和纤维化。
共有 260 例患者，其中 58 例（22.3%）发生了 SRILT。SRILT 组和非-SRILT 组患者的平均 FEV1 值分别为 71.7%和 65.9%（P=.077）。单因素分析显示，SRILT 的风险随 MLD 增加（P=.008）、无 COPD（P=.047）和 FEV1 增加（P=.077）而增加。年龄（65 岁分组）和 MLD 在多因素分析中与 SRILT 显著相关。FEV1 和年龄与 MLD 模型的结合略微提高了 SRILT 的预测能力（曲线下面积从 0.63-0.70，P=.088）。
基线 PF 较差不会增加 SRILT 的风险，结合 FEV1、年龄和 MLD 可能会提高预测能力。
