容积调强弧形治疗降低局部晚期非小细胞肺癌放疗中≥2 级放射性肺炎发生率的潜在获益。

Potential benefits of volumetric modulated arc therapy to reduce the incidence of ≥ grade 2 radiation pneumonitis in radiotherapy for locally advanced non-small cell lung cancer patients.

机构信息

Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan.

Department of Radiation Oncology, Kochi Medical School, Kochi University, Nankoku-shi, Kochi, Japan.

出版信息

Jpn J Clin Oncol. 2021 Dec 1;51(12):1729-1735. doi: 10.1093/jjco/hyab163.

DOI:10.1093/jjco/hyab163

PMID:34625805

Abstract

BACKGROUND

The use of volumetric modulated arc therapy is gradually widespread for locally advanced non-small cell lung cancer. The purpose of this study was to identify the factors that caused ≥ grade 2 radiation pneumonitis and evaluate the impact of using volumetric modulated arc therapy on the incidence of ≥ grade 2 radiation pneumonitis by comparing three-dimensional conformal radiation therapy.

METHODS

We retrospectively evaluated 124 patients who underwent radical radiotherapy for locally advanced non-small cell lung cancer in our institution between 2008 and 2019. The following variables were analysed to detect the factors that affected ≥ grade 2 radiation pneumonitis; age, sex, the presence of interstitial lung disease, pulmonary emphysema, tumour location, stage, PTV/lung volume, lung V20Gy, total dose, concurrent chemoradiotherapy, adjuvant immune checkpoint inhibitor, radiotherapy method. Radiation pneumonitis was evaluated using the common terminology criteria for adverse events (version 5.0).

RESULTS

A total of 84 patients underwent three-dimensional conformal radiation therapy (3D-CRT group) and 40 patients underwent volumetric modulated arc therapy (VMAT group). The cumulative incidence of ≥ grade 2 radiation pneumonitis at 12 months was significantly lower in the VMAT group than in the 3D-CRT group (25% vs. 49.1%). The use of volumetric modulated arc therapy was a significant factor for ≥ grade 2 radiation pneumonitis (HR:0.32, 95% CI: 0.15-0.65, P = 0.0017) in addition to lung V20Gy (≥ 24%, HR:5.72 (95% CI: 2.87-11.4), P < 0.0001) and total dose (≥ 70 Gy, HR:2.64 (95% CI: 1.39-5.03), P = 0.0031) even after adjustment by multivariate analysis.

CONCLUSIONS

We identified factors associated with ≥ grade 2 radiation pneumonitis in radiotherapy for patients with locally advanced non-small cell lung cancer. Volumetric modulated arc therapy has potential benefits to reduce the risk of ≥ grade 2 radiation pneumonitis.

摘要

背景

容积调强弧形治疗逐渐广泛应用于局部晚期非小细胞肺癌。本研究旨在确定导致≥2 级放射性肺炎的因素，并通过比较三维适形放疗来评估使用容积调强弧形治疗对≥2 级放射性肺炎发生率的影响。

方法

我们回顾性评估了 2008 年至 2019 年间在我院接受根治性放疗的 124 例局部晚期非小细胞肺癌患者。分析以下变量以检测影响≥2 级放射性肺炎的因素；年龄、性别、是否存在间质性肺疾病、肺气肿、肿瘤位置、分期、PTV/肺体积、肺 V20Gy、总剂量、同期放化疗、辅助免疫检查点抑制剂、放疗方法。放射性肺炎采用不良事件通用术语标准（版本 5.0）进行评估。

结果

共有 84 例患者接受三维适形放疗（3D-CRT 组），40 例患者接受容积调强弧形治疗（VMAT 组）。VMAT 组 12 个月时≥2 级放射性肺炎的累积发生率明显低于 3D-CRT 组（25%比 49.1%）。除了肺 V20Gy（≥24%，HR：5.72（95%CI：2.87-11.4），P<0.0001）和总剂量（≥70Gy，HR：2.64（95%CI：1.39-5.03），P=0.0031）外，容积调强弧形治疗（HR：0.32，95%CI：0.15-0.65，P=0.0017）也是≥2 级放射性肺炎的显著因素，即使在多变量分析调整后也是如此。