Zhao Jing, Yorke Ellen D, Li Ling, Kavanagh Brian D, Li X Allen, Das Shiva, Miften Moyed, Rimner Andreas, Campbell Jeffrey, Xue Jinyu, Jackson Andrew, Grimm Jimm, Milano Michael T, Spring Kong Feng-Ming
Department of Radiation Oncology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, Georgia; Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York.
Int J Radiat Oncol Biol Phys. 2016 Aug 1;95(5):1357-1366. doi: 10.1016/j.ijrobp.2016.03.024. Epub 2016 Mar 25.
To study the risk factors for radiation-induced lung toxicity (RILT) after stereotactic body radiation therapy (SBRT) of the thorax.
Published studies on lung toxicity in patients with early-stage non-small cell lung cancer (NSCLC) or metastatic lung tumors treated with SBRT were pooled and analyzed. The primary endpoint was RILT, including pneumonitis and fibrosis. Data of RILT and risk factors were extracted from each study, and rates of grade 2 to 5 (G2+) and grade 3 to 5 (G3+) RILT were computed. Patient, tumor, and dosimetric factors were analyzed for their correlation with RILT.
Eighty-eight studies (7752 patients) that reported RILT incidence were eligible. The pooled rates of G2+ and G3+ RILT from all 88 studies were 9.1% (95% confidence interval [CI]: 7.15-11.4) and 1.8% (95% CI: 1.3-2.5), respectively. The median of median tumor sizes was 2.3 (range, 1.4-4.1) cm. Among the factors analyzed, older patient age (P=.044) and larger tumor size (the greatest diameter) were significantly correlated with higher rates of G2+ (P=.049) and G3+ RILT (P=.001). Patients with stage IA versus stage IB NSCLC had significantly lower risks of G2+ RILT (8.3% vs 17.1%, odds ratio = 0.43, 95% CI: 0.29-0.64, P<.0001). Among studies that provided detailed dosimetric data, the pooled analysis demonstrated a significantly higher mean lung dose (MLD) (P=.027) and V20 (P=.019) in patients with G2+ RILT than in those with grade 0 to 1 RILT.
The overall rate of RILT is relatively low after thoracic SBRT. Older age and larger tumor size are significant adverse risk factors for RILT. Lung dosimetry, specifically lung V20 and MLD, also significantly affect RILT risk.
研究胸部立体定向体部放射治疗（SBRT）后放射性肺毒性（RILT）的危险因素。
汇总并分析已发表的关于早期非小细胞肺癌（NSCLC）或转移性肺肿瘤患者接受SBRT治疗后肺毒性的研究。主要终点是RILT，包括肺炎和肺纤维化。从每项研究中提取RILT和危险因素的数据，并计算2至5级（G2+）和3至5级（G3+）RILT的发生率。分析患者、肿瘤和剂量学因素与RILT的相关性。
88项报告RILT发生率的研究（7752例患者）符合要求。所有88项研究中G2+和G3+ RILT的汇总发生率分别为9.1%（95%置信区间[CI]：7.15-11.4）和1.8%（95%CI：1.3-2.5）。肿瘤大小中位数的中位数为2.3（范围，1.4-4.1）cm。在分析的因素中，患者年龄较大（P=0.044）和肿瘤尺寸较大（最大直径）与G2+（P=0.049）和G3+ RILT发生率较高显著相关（P=0.001）。IA期与IB期NSCLC患者发生G2+ RILT的风险显著较低（8.3%对17.1%，比值比=0.43，95%CI：0.29-0.64，P<0.0001）。在提供详细剂量学数据的研究中，汇总分析表明，发生G2+ RILT的患者的平均肺剂量（MLD）（P=0.027）和V20（P=0.019）显著高于0至1级RILT患者。
胸部SBRT后RILT的总体发生率相对较低。年龄较大和肿瘤尺寸较大是RILT的重要不良危险因素。肺剂量学，特别是肺V20和MLD，也显著影响RILT风险。
