放射性肺炎的预后分析：局部晚期肺癌患者的碳离子放疗
Prognostic analysis of radiation pneumonitis: carbon-ion radiotherapy in patients with locally advanced lung cancer.
作者信息
Hayashi Kazuhiko, Yamamoto Naoyoshi, Karube Masataka, Nakajima Mio, Matsufuji Naruhiro, Tsuji Hiroshi, Ogawa Kazuhiko, Kamada Tadashi
机构信息
Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage Ward, Chiba City, Chiba Prefecture, Japan.
Department of Radiotherapy, Mitsui Memorial Hospital, Tokyo, Japan.
出版信息
Radiat Oncol. 2017 May 30;12(1):91. doi: 10.1186/s13014-017-0830-z.
BACKGROUND
Carbon-ion radiotherapy (CIRT) is a promising treatment for locally advanced non-small-cell lung cancer, especially for patients with inoperable lung cancer. Although the incidence of CIRT-induced radiation pneumonitis (RP) ≥ grade 2 ranges from 2.5 to 9.9%, the association between CIRT-induced RP and dosimetric parameters is not clear. Herein, we identified prognostic factors associated with symptomatic RP after CIRT for patients with non-small-cell lung cancer.
METHODS
Clinical results of 65 patients treated with CIRT between 2000 and 2015 at the National Institute of Radiological Sciences were retrospectively analyzed. Clinical stage II B disease (TNM classification) was the most common stage among the patients (45%). The median radiation dose was 72 Gy (68-76) relative biological effectiveness (RBE) in 16 fractions. In cases involving metastatic lymph nodes, prophylactic irradiation of mediastinal lymph nodes was performed at a median dose of 49.5 Gy (RBE). The median follow-up was 22 months.
RESULTS
Grade 2 and grade 3 RP occurred in 6 and 3 patients (9 and 5%), respectively. No patients developed grade 4 or 5 RP. Using univariate analysis, vital capacity as a percentage of predicted (%VC), forced expiratory volume in 1 s (FEV1), mean lung dose (MLD), volume of lung receiving ≥5 Gy (RBE) (V), V, V and V were determined to be the significant predictive factors for ≥ grade 2 RP. The receiver operating characteristic (ROC) analysis revealed the cutoff values for %VC, FEV1, MLD, V, V, V and V for ≥ grade 2 RP, which were 86.9%, 1.16 L, 12.5 Gy (RBE), 28.8, 29.9, 20.1 and 15.0%, respectively. In addition, the multivariate analysis revealed that %VC <86.9% (odds ratio = 13.7; p = 0.0041) and V ≥ 15% (odds ratio = 6.1; p = 0.0221) were significant risk factors.
CONCLUSIONS
Our study demonstrated the risk factors for ≥ grade 2 RP after carbon-ion radiotherapy for patients with locally advanced lung cancer.
背景
碳离子放射治疗（CIRT）是局部晚期非小细胞肺癌的一种有前景的治疗方法，尤其适用于无法手术的肺癌患者。尽管CIRT诱导的≥2级放射性肺炎（RP）的发生率在2.5%至9.9%之间，但CIRT诱导的RP与剂量学参数之间的关联尚不清楚。在此，我们确定了局部晚期非小细胞肺癌患者CIRT后有症状RP的预后因素。
方法
回顾性分析了2000年至2015年间在日本国立放射科学研究所接受CIRT治疗的65例患者的临床结果。临床II B期疾病（TNM分类）是患者中最常见的阶段（45%）。中位放射剂量为72 Gy（68 - 76）相对生物效应（RBE），分16次给予。在涉及转移性淋巴结的病例中，纵隔淋巴结的预防性照射中位剂量为49.5 Gy（RBE）。中位随访时间为22个月。
结果
分别有6例和3例患者发生2级和3级RP（9%和5%）。无患者发生4级或5级RP。单因素分析显示，预测肺活量百分比（%VC）、第1秒用力呼气量（FEV1）、平均肺剂量（MLD）、接受≥5 Gy（RBE）的肺体积（V）、V、V和V被确定为≥2级RP的显著预测因素。受试者工作特征（ROC）分析显示了≥2级RP的%VC、FEV1、MLD、V、V、V和V的截断值，分别为86.9%、1.16 L、12.5 Gy（RBE）、28.8、29.9、20.1和15.0%。此外，多因素分析显示%VC <86.9%（比值比 = 13.7；p = 0.0041）和V≥15%（比值比 = 6.1；p = 0.0221）是显著危险因素。
结论
我们的研究证明了局部晚期肺癌患者碳离子放射治疗后≥2级RP的危险因素。
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