Respiratory Division, University Hospital UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium.
Strahlenther Onkol. 2020 Feb;196(2):142-150. doi: 10.1007/s00066-019-01489-8. Epub 2019 Jul 12.
To evaluate alterations in pulmonary function indices after helical tomotherapy and explore potential associations with biologically corrected dosimetric parameters.
In 64 patients with inoperable locally advanced non-small cell lung cancer, pulmonary function tests before and within 6 months after radiotherapy were evaluated retrospectively. In the case of concurrent chemotherapy a total dose of 67.2 Gy was delivered, otherwise 70.5 Gy was provided. In 44 patients, late pulmonary function changes (≥6 months after radiotherapy) could also be assessed.
In the entire patient group, there were significant declines in forced expiratory volume in 1s (FEV) (average change -4.1% predicted; P = 0.007), in forced vital capacity (FVC) (-4.9% predicted; P = 0.002), total lung capacity (TLC) (-5.8% predicted; P = 0.0016) and DL (diffusing capacity of the lung for carbon monoxide corrected for hemoglobin level) (-8.6% predicted; P < 0.001) during the first 6 months. Corresponding FEV, FVC, TLC and DL declines in the subgroup with late measurements (after 11.3 months on average) were -5.7, -7.4, -7.0, -9.8% predicted. A multivariate analysis including V , V , V , V , V , mean lung dose (MLD), gross tumor volume (GTV) and planning target volume (PTV) as potential covariates showed that GTV was the most consistent contributor, being significant for ∆FEV (P = 0.003), ∆FVC (P = 0.003), ∆TLC (P = 0.001) and ∆DL (P = 0.01). V or V did not contribute to any of the lung function changes.
The decline in pulmonary function indices after helical tomotherapy was of similar magnitude to that observed in studies reporting the effect of conformal radiotherapy on lung function. Diffusion capacity was the parameter showing the largest decrease following radiation therapy as compared to baseline and correlated with gross tumor volume. None of the alterations in pulmonary function tests were associated with the lung volume receiving low-dose radiation.
评估螺旋断层放疗后肺功能指标的变化，并探讨与生物校正剂量学参数的潜在关联。
回顾性分析 64 例局部晚期非小细胞肺癌不可手术患者的放疗前后肺功能检查结果。在同期放化疗的情况下，给予总剂量 67.2Gy，否则给予 70.5Gy。在 44 例患者中，还可评估放疗后 6 个月以上的晚期肺功能变化。
在整个患者组中，用力呼气量 1 秒（FEV1）（平均变化-4.1%预测值；P=0.007）、用力肺活量（FVC）（-4.9%预测值；P=0.002）、总肺容量（TLC）（-5.8%预测值；P=0.0016）和一氧化碳弥散量（血红蛋白校正后的肺弥散量）（-8.6%预测值；P<0.001）在 6 个月内均显著下降。在有晚期测量值（平均 11.3 个月后）的亚组中，相应的 FEV1、FVC、TLC 和 DL 下降分别为-5.7%、-7.4%、-7.0%和-9.8%预测值。包括 V20、V30、V40、V50、V5、平均肺剂量（MLD）、大体肿瘤体积（GTV）和计划靶区（PTV）作为潜在协变量的多变量分析显示，GTV 是最一致的贡献因素，对 ∆FEV（P=0.003）、∆FVC（P=0.003）、∆TLC（P=0.001）和 ∆DL（P=0.01）均有显著影响。V20 或 V30 与任何肺功能变化均无相关性。
螺旋断层放疗后肺功能指标的下降与报道的适形放疗对肺功能影响的研究相似。与基线相比，弥散能力是放疗后下降最大的参数，与大体肿瘤体积相关。肺功能检查的任何改变均与低剂量照射的肺体积无关。
