Zhou Zhi-Rui, Han Qing, Liang Shi-Xiong, He Xiao-Dong, Cao Nu-Yun, Zi Ying-Jie
Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai, P.R.China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R.China.
Oncotarget. 2017 May 16;8(20):33855-33863. doi: 10.18632/oncotarget.12979.
To investigate the relationship between dosimetric factors, including Lyman normal-tissue complication (NTCP) parameters and radiation-induced lung injury (RILI), in postoperative breast cancer patients treated by intensity modulated radiotherapy (IMRT). 109 breast cancer patients who received IMRT between January 2012 and December 2013 were prospectively enrolled. A maximum likelihood analysis yielded the best estimates for Lyman NTCP parameters. Ten patients were diagnosed with RILI (primarily Grade 1 or Grade 2 RILI); the rate of RILI was 9.17% (10/109). Multivariate analysis demonstrated that ipsilateral lung V20 was an independent predictor (P=0.001) of RILI. Setting V20=29.03% as the cut-off value, the prediction of RILI achieved high accuracy (94.5%), with a sensitivity of 80% and specificity of 96%. The NTCP model parameters for 109 patients were m=0.437, n=0.912, and TD50(1)=17.211 Gy. The sensitivity of the modified Lyman NTCP model to predict the RILI was 90% (9/10), the specificity was 69.7% (69/99), and the accuracy was 71.6% (78/109). The RILI rate of the NTCP<9.62% in breast cancer patients was 1.43% (1/70), but the RILI rate of the NTCP>9.62% in patients with breast cancer was 23.08% (9/39), (P=0.001). In conclusion, V20 is an independent predictive factor for RILI in patients with breast cancer treated by IMRT; V20=29.03% could be a useful dosimetric parameter to predict the risk of RILI. The Lyman NTCP model parameters of the new value (m=0.437, n=0.912, TD50 (1) =17.211 Gy) can be used as an effective biological index to evaluate the risk of RILI.
为研究在接受调强放疗（IMRT）的术后乳腺癌患者中，包括莱曼正常组织并发症（NTCP）参数在内的剂量学因素与放射性肺损伤（RILI）之间的关系。前瞻性纳入了2012年1月至2013年12月期间接受IMRT的109例乳腺癌患者。通过最大似然分析得出莱曼NTCP参数的最佳估计值。10例患者被诊断为RILI（主要为1级或2级RILI）；RILI发生率为9.17%（10/109）。多因素分析表明，同侧肺V20是RILI的独立预测因素（P = 0.001）。将V20 = 29.03%设定为临界值，RILI预测的准确率较高（94.5%），敏感性为80%，特异性为96%。109例患者的NTCP模型参数为m = 0.437，n = 0.912，TD50(1) = 17.211 Gy。改良的莱曼NTCP模型预测RILI的敏感性为90%（9/10），特异性为69.7%（69/99），准确率为71.6%（78/109）。乳腺癌患者中NTCP < 9.62%的RILI发生率为1.43%（1/70），但乳腺癌患者中NTCP > 9.62%的RILI发生率为23.08%（9/39），（P = 0.001）。总之，V20是接受IMRT治疗的乳腺癌患者RILI的独立预测因素；V20 = 29.03%可能是预测RILI风险的有用剂量学参数。新值（m = 0.437，n = 0.912，TD50(1) = 17.211 Gy）的莱曼NTCP模型参数可作为评估RILI风险的有效生物学指标。
