Liu Z, Su J, Shen W, Li Y, Li S, Zhu S
The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei.
Med Phys. 2012 Jun;39(6Part13):3761. doi: 10.1118/1.4735317.
The aim of this study was to analyze the affect factors with radiation induced lung injury of NSCLC treated by 3DCRT, in order to supply reference criteria for optimize the treatment planning, further to improve the local control rate and the quality of life of NSCLC patients.
From August 2000 to December 2004, 107 NSCLC patients received 3DCRT were retrospectively enrolled in this study. All of patients received the prescription doses ranged from 60-68Gy with a median dose of 66Gy. Dosimetric parameters of dose-volume histograms from 3DCRT plans was recorded. The lung injury were assessed for each patient during the treatment and follow-up within 3 months after treatment completion. Acute radiation induced pneumonitis were graded by one radiation oncologist according to the RTOG/EORTC criteria. The correlation between dosimetric parameters with lung injury was evaluated by univariate and multivariate analysis using Logistic Regression Model of SPSS11.0 software.
In the 107 patients of NSCLC, the rate of irradiated induced lung injury was 62.6% and the rate of =2 grade radiation induced pneumonitis was 38.3%. Twenty-three cases were classified in grade 2, fourteen cases in grade 3, four cases in grade 4. Univariate analysis showed chronic obstructive pulmonary disease(COPD), number of beams field, lung mean dose, lung V5-V40 were important parameters on radiation induced lung injury. The rate of =2 grade lung injury was 56.3%(18/32) in patients accompany COPD, compared with 30.7%(23/75) of those without COPD. In the same way,the rate of =2 grade lung injury was 61.9%(26/42) in patients of lung mean dose=20Gy, which higher than 19.4%(12/62) of lung mean dose<20Gy. Further more, lung mean dose, lung V20 and COPD were likely to be the independent factors of radiation induced lung injury by Logistic Regression Model.
lung mean dose, lung V20 and COPD were the independent affect factors on irradiated induced lung injury. Our funding support received from National Natural Science Foundation of China (30870743).
本研究旨在分析三维适形放疗（3DCRT）治疗非小细胞肺癌（NSCLC）时放射性肺损伤的影响因素，为优化治疗计划提供参考标准，进而提高NSCLC患者的局部控制率和生活质量。
回顾性纳入2000年8月至2004年12月期间接受3DCRT治疗的107例NSCLC患者。所有患者接受的处方剂量范围为60 - 68Gy，中位剂量为66Gy。记录3DCRT计划中剂量体积直方图的剂量学参数。在治疗期间及治疗完成后3个月内的随访中对每位患者的肺损伤进行评估。由一名放射肿瘤学家根据RTOG/EORTC标准对急性放射性肺炎进行分级。使用SPSS11.0软件的逻辑回归模型通过单因素和多因素分析评估剂量学参数与肺损伤之间的相关性。
在107例NSCLC患者中，放射性肺损伤发生率为62.6%，≥2级放射性肺炎发生率为38.3%。23例为2级，14例为3级，4例为4级。单因素分析显示慢性阻塞性肺疾病（COPD）、射野数量、肺平均剂量、肺V5 - V40是放射性肺损伤的重要参数。伴有COPD的患者中≥2级肺损伤发生率为56.3%（18/32），而无COPD的患者为30.7%（23/75）。同样，肺平均剂量≥20Gy的患者中≥2级肺损伤发生率为61.9%（26/42），高于肺平均剂量<20Gy的患者的19.4%（12/62）。此外，通过逻辑回归模型分析，肺平均剂量、肺V20和COPD可能是放射性肺损伤的独立因素。
肺平均剂量、肺V20和COPD是放射性肺损伤独立的影响因素。本研究得到中国国家自然科学基金（30870743）资助。
