Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Int J Radiat Oncol Biol Phys. 2018 Jul 15;101(4):919-926. doi: 10.1016/j.ijrobp.2018.04.012. Epub 2018 Apr 12.
To identify clinical and dosimetric factors that would predict grade ≥2 radiation pneumonitis (RP) for patients undergoing postoperative radiation therapy (PORT) for non-small cell lung cancer (NSCLC); and to use the factors identified to generate a predictive model to quantify risk of RP in such patients.
We retrospectively reviewed radiation therapy, radiographic, and clinical data from 199 patients who had received PORT, with or without chemotherapy, for NSCLC. Potential associations between dosimetric and clinical factors and RP were evaluated in univariate and multivariate Cox regression hazard models and competing risk analysis. Kaplan-Meier analysis was used to estimate overall survival and the cumulative incidence of RP, and receiver operating characteristic curve analysis to identify cutpoints for variables found to influence RP risk. The endpoint was grade ≥2 RP (symptomatic, requiring steroids or limiting instrumental activities of daily living).
Thirty-seven patients (19%) developed grade ≥2 RP. Patient-related factors, type of surgery or chemotherapy, and radiation therapy-related factors were not associated with grade ≥2 RP; only lung V10 > 30% and lung V20 > 20% predicted grade ≥2 RP. Risk groupings were as follows: high risk, V10 > 30% and V20 > 20% (24 of 72 patients, 33%); intermediate risk, V10 > 30% and V20 ≤ 20% or V10 ≤ 30% and V20 > 20% (6 of 26 patients, 23%); and low risk, V10 ≤ 30% and V20 ≤ 20% (6 of 101 patients, 6%) (P < .0001). In a subgroup analysis of patients who had had lobectomy, corresponding incidences of RP were as follows: high risk, 20 of 59 (34%); intermediate risk, 5 of 22 (23%); and low risk, 6 of 70 (9%) (P = .001).
The lung dose-volume variables V10 and V20 predicted risk of grade ≥2 RP among patients who underwent PORT for NSCLC.
确定可预测非小细胞肺癌（NSCLC）患者术后接受放疗（PORT）后发生 2 级及以上放射性肺炎（RP）的临床和剂量学因素，并利用这些因素建立预测模型，量化此类患者发生 RP 的风险。
我们回顾性分析了 199 例接受 PORT（联合或不联合化疗）治疗 NSCLC 的患者的放射治疗、影像学和临床资料。在单变量和多变量 Cox 回归风险模型及竞争风险分析中评估了剂量学和临床因素与 RP 之间的潜在关联。Kaplan-Meier 分析用于估计总生存期和 RP 的累积发生率，ROC 曲线分析用于确定影响 RP 风险的变量的切点。结局为 2 级及以上 RP（有症状，需要使用类固醇或限制日常生活活动的能力）。
37 例（19%）患者发生 2 级及以上 RP。患者相关因素、手术类型或化疗以及放射治疗相关因素与 2 级及以上 RP 无关；仅肺 V10>30%和 V20>20%预测 2 级及以上 RP。风险分组如下：高危，V10>30%和 V20>20%（72 例患者中的 24 例，33%）；中危，V10>30%和 V20≤20%或 V10≤30%和 V20>20%（26 例患者中的 6 例，23%）；低危，V10≤30%和 V20≤20%（101 例患者中的 6 例，6%）（P<0.0001）。在接受肺叶切除术的患者亚组分析中，RP 的发生率如下：高危，59 例中的 20 例（34%）；中危，22 例中的 5 例（23%）；低危，70 例中的 6 例（9%）（P=0.001）。
在接受 PORT 治疗 NSCLC 的患者中，肺剂量-体积参数 V10 和 V20 预测 2 级及以上 RP 的风险。
