Wu Kan, Xu Xiao, Li Xiadong, Wang Jiahao, Zhu Lucheng, Chen Xueqin, Wang Bing, Zhang Minna, Xia Bing, Ma Shenglin
Department of Oncology, The Fourth Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou First People's Hospital, Hangzhou Cancer Hospital, Hangzhou 310006, China.
Department of Radiation Oncology, The Fourth Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou First People's Hospital, Hangzhou Cancer Hospital, Hangzhou 310006, China.
J Thorac Dis. 2018 Dec;10(12):6531-6539. doi: 10.21037/jtd.2018.11.132.
Few studies to date have assessed the incidence of radiation pneumonitis (RP) in lung cancer patients who have been treated with volumetric modulated arc therapy (VMAT). This study is aimed at reporting the RP incidence rate and the risk factors associated with a symptomatic RP in patients with lung cancer treated with VMAT.
A total of 77 consecutive lung cancer patients treated with VMAT from 2013 through 2015 were reviewed. RP severity was graded according to the Common Terminology Criteria for Adverse Events (CTCEA) v.4. Univariate and multivariate analyses were performed to identify the significant factors associated with RP.
VMAT allowed us to achieve most planning objectives on the target volumes and organs at risk, for PTV V =96.8%±3.1%, for lung V =41.3%±8.7%, V =30.0%±7.1%, V =20.9%±5.7%, for heart V =43.2%±29.9%, for esophagus V =8.1%±12.9%. The maximum dose of spinal cord was 34.4±9.5 Gy. The overall incidence of symptomatic RP (grade ≥2 by CTCAE) was 28.6% in the entire cohort, and the rate of grade ≥3 RP was 11.7%. Based on the multivariate analysis, factors predictive of symptomatic RP included lung volume receiving ≥10 Gy (V) (P=0.019) and C-reactive protein changing level (P=0.013).
Our data showed that the incidence rate of RP was acceptable in lung cancer patients treated with VMAT. Additionally, we found that V might be an important factor for predicting the development of RP when VMAT was used; but this observation needs to be validated in future studies.
迄今为止，很少有研究评估接受容积调强弧形放疗（VMAT）的肺癌患者放射性肺炎（RP）的发生率。本研究旨在报告接受VMAT治疗的肺癌患者的RP发生率以及与有症状RP相关的危险因素。
回顾了2013年至2015年期间连续接受VMAT治疗的77例肺癌患者。根据不良事件通用术语标准（CTCEA）第4版对RP严重程度进行分级。进行单因素和多因素分析以确定与RP相关的显著因素。
VMAT使我们能够在靶区体积和危及器官上实现大多数计划目标，计划靶体积（PTV）的V96.8%±3.1%，肺的V41.3%±8.7%，V30.0%±7.1%，V20.9%±5.7%，心脏的V43.2%±29.9%，食管的V8.1%±12.9%。脊髓的最大剂量为34.4±9.5 Gy。整个队列中有症状RP（CTCAE分级≥2级）的总体发生率为28.6%，≥3级RP的发生率为11.7%。基于多因素分析，有症状RP的预测因素包括接受≥10 Gy（V）的肺体积（P=0.019）和C反应蛋白变化水平（P=0.013）。
我们的数据表明，接受VMAT治疗的肺癌患者中RP的发生率是可以接受的。此外，我们发现当使用VMAT时，V可能是预测RP发生的一个重要因素；但这一观察结果需要在未来的研究中得到验证。
