School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China.
Shandong Cancer Hospital and Institute- Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong, China.
Sci Rep. 2017 Mar 15;7:44646. doi: 10.1038/srep44646.
This study aimed to find a better dosimetric parameter in predicting of radiation-induced lung toxicity (RILT) in patients with non-small cell lung cancer (NSCLC) individually: ventilation(V), perfusion (Q) or computerized tomography (CT) based. V/Q single-photon emission computerized tomography (SPECT) was performed within 1 week prior to radiotherapy (RT). All V/Q imaging data was integrated into RT planning system, generating functional parameters based on V/Q SPECT. Fifty-seven NSCLC patients were enrolled in this prospective study. Fifteen (26.3%) patients underwent grade ≥2 RILT, the remaining forty-two (73.7%) patients didn't. Q-MLD, Q-V20, V-MLD, V-V20 of functional parameters correlated more significantly with the occurrence of RILT compared to V20, MLD of anatomical parameters (r = 0.630; r = 0.644; r = 0.617; r = 0.651 vs. r = 0.424; r = 0.520 p < 0.05, respectively). In patients with chronic obstructive pulmonary diseases (COPD), V functional parameters reflected significant advantage in predicting RILT; while in patients without COPD, Q functional parameters reflected significant advantage. Analogous results were existed in fractimal analysis of global pulmonary function test (PFT). In patients with central-type NSCLC, V parameters were better than Q parameters; while in patients with peripheral-type NSCLC, the results were inverse. Therefore, this study demonstrated that choosing a suitable dosimetric parameter individually can help us predict RILT accurately.
本研究旨在寻找一种更好的剂量学参数，以单独预测非小细胞肺癌（NSCLC）患者的放射性肺毒性（RILT）：基于通气（V）、灌注（Q）或计算机断层扫描（CT）的参数。V/Q 单光子发射计算机断层扫描（SPECT）在放射治疗（RT）前 1 周内进行。所有 V/Q 成像数据均整合到 RT 计划系统中，基于 V/Q SPECT 生成功能参数。本前瞻性研究共纳入 57 例 NSCLC 患者。15 例（26.3%）患者发生≥2 级 RILT，其余 42 例（73.7%）患者未发生。与解剖参数的 V20 和 MLD 相比，功能参数的 Q-MLD、Q-V20、V-MLD 和 V-V20 与 RILT 的发生更显著相关（r=0.630；r=0.644；r=0.617；r=0.651 与 r=0.424；r=0.520，p<0.05）。在慢性阻塞性肺疾病（COPD）患者中，V 功能参数在预测 RILT 方面表现出显著优势；而在无 COPD 的患者中，Q 功能参数则表现出显著优势。全肺功能测试（PFT）的分形分析也存在类似结果。在中央型 NSCLC 患者中，V 参数优于 Q 参数；而在周围型 NSCLC 患者中，结果则相反。因此，本研究表明，单独选择合适的剂量学参数可以帮助我们准确预测 RILT。
