Marks L B, Munley M T, Bentel G C, Zhou S M, Hollis D, Scarfone C, Sibley G S, Kong F M, Jirtle R, Jaszczak R, Coleman R E, Tapson V, Anscher M
Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
Int J Radiat Oncol Biol Phys. 1997 Oct 1;39(3):563-70. doi: 10.1016/s0360-3016(97)00343-x.
To develop methods of predicting the pulmonary consequences of thoracic irradiation (RT) by prospectively studying changes in pulmonary function following RT.
100 patients receiving incidental partial-lung irradiation during treatment of tumors in or adjacent to the thorax had whole-lung function assessed via symptoms and pulmonary function tests (PFTs: FEV1-forced expiratory volume 1 s; DLCO-diffusion capacity) before and repeatedly 6-48 months following RT. All had computed tomography-based three-dimensional (3D) dose calculations with lung density heterogeneity corrections for dose-volume histogram (DVH) and normal tissue complication probability (NTCP) calculations. Functional DVHs (DVfH) based on SPECT (single photon emission computed tomography) lung perfusion scans, and serial transforming growth factor-beta (TGF-beta1) levels were available in 50 and 48 patients, respectively. The incidence and severity of changes in whole-lung function were correlated with clinical, physical, and biological factors. Exploratory statistical analyses were performed using chi-square, Pearson correlations, logistic regression, and multiple linear regression.
RT-induced symptoms developed in 21 patients. In the overall group, the single best predictor for the development of symptoms was the NTCP (p < 0.05). Pre-RT PFTs alone were less predictive (p = 0.1 for FEV1, p = 0.08 for DLCO). A multivariate model based on pre-RT DLCO and CT-based NTCP was strongly predictive for the development of symptoms (p < 0.001). NTCPs based on SPECT-derived DVf Hs and TGF-beta1 levels did not appear to provide additional predictive value. The presence or absence of pulmonary symptoms was correlated with the decline in PFT 6 months following RT (p < 0.05). In the overall group, the degree of decline in PFTs was not well correlated with any of the dose-volume variables considered. In patients with "good" pre-RT PFTs, there was a relationship between the percent reduction in PFT and dose-volume parameters such as the percent of lung volume receiving > 30 Gy (p < 0.05).
The extent of alteration in whole-lung function (symptoms or PFT changes) appears to be related to both dose-volume and pre-RT PFT parameters. The data suggest that no one variable is likely to be an adequate predictor and that multivariate predictive models will be needed. Additional studies are underway to develop better predictive models that consider physical factors such as the DVH and regional perfusion, as well as biological/clinical factors such as pre-RT PFTs and TGF-beta1.
通过前瞻性研究胸部放疗（RT）后肺功能的变化，开发预测胸部放疗肺部后果的方法。
100例在胸部或其附近肿瘤治疗期间接受偶然部分肺照射的患者，在放疗前以及放疗后6 - 48个月多次通过症状和肺功能测试（PFTs：第1秒用力呼气量（FEV1）；肺一氧化碳弥散量（DLCO））评估全肺功能。所有患者均进行基于计算机断层扫描的三维（3D）剂量计算，并对剂量 - 体积直方图（DVH）和正常组织并发症概率（NTCP）计算进行肺密度异质性校正。分别有50例和48例患者可获得基于单光子发射计算机断层扫描（SPECT）肺灌注扫描的功能DVH（DVfH）以及系列转化生长因子 - β（TGF - β1）水平。全肺功能变化的发生率和严重程度与临床、体格和生物学因素相关。使用卡方检验、Pearson相关性分析、逻辑回归和多元线性回归进行探索性统计分析。
21例患者出现放疗引起的症状。在整个研究组中，症状发生的最佳单一预测指标是NTCP（p < 0.05）。仅放疗前的PFTs预测性较差（FEV1的p = 0.1，DLCO的p = 0.08）。基于放疗前DLCO和基于CT的NTCP的多变量模型对症状发生具有很强的预测性（p < 0.001）。基于SPECT衍生的DVfH和TGF - β1水平的NTCP似乎未提供额外的预测价值。肺部症状的有无与放疗后6个月PFT的下降相关（p <
