Ⅲ+Ⅳ期非小细胞肺癌三维适形或调强放疗中复合指标预测放射性肺炎前瞻性临床研究

目的 探讨非小细胞肺癌三维适形或调强放疗正常肺V5和V10联合V20评价放射性肺炎(RP)的意义.方法 采用三维适形或调强后程加速超分割放疗经病理或细胞学证实初治非小细胞肺癌患者90例,其中Ⅲa期6例、Ⅲb期29例、Ⅳ期55例.放疗剂量61～80 Gy,中位数70 Gy.由剂量体积直方图计算全肺V5、V10、V20、V30、平均肺剂量(MLD),对侧肺V5、V10及同侧肺V30.用CTC3.0标准评估肺损伤.结果 90例患者中发生RP为1级29例、2级23例、3级5例、4级1例、5级1例.全肺V5、V10、V20、对侧肺V10、大体肿瘤体积(GTV)、计划靶体积、射野数目与≥1级RP相关(χ2=2.04、2.05、2.01、4.62、6.50、5.61、5.61,P=0.044、0.043、0.047、0.030、0.010、0.020、0.020),全肺V5、V10、V20和V30、MLD与≥2级RP相关(χ2=2.05、2.20、2.96、4.96、5.20,P=0.040、0.030、0.000、0.030、0.020).多因素分析显示GTV与≥1级RP发生相关(χ2=4.06,P=0.044),V20与≥2级RP发生相关(χ2=9.61,P=0.002).全肺V5、V10、V20的中位数分别为66%、48%、31%.V20>31%时≥2级RP概率增加,V20>31%+V10>48%+V5>66%时≥2级RP概率增加,V20>31%+V5>66%时≥2级RP概率增加;V20>31%时V10>48%与<48%比较RP概率相似,V20≤31%时V5>66%与<66%、V10>48%与<48%比较RP概率也相似.性别、年龄、临床分期、病理类型、治疗方式、KPS与≥1、2级RP无关.结论 肺V5、V10联合V20评价放射性肺炎的发生可能提高预测放射性肺炎的能力.

Comprehensive parameters in predicting radiation pneumonitis in advanced stage non-small-cell lung cancer treated with three-dimensional conformal or intensity-modulated radiation therapy

Objective To analyze relation of comprehensive parameters of the dose-volume V5,V10 and V20 with radiation pneumonitis (RP) in patients with advanced stage non-small-cell lung cancer (NSCLC) treated with three-dimensional conformal (3DCRT) or intensity-modulated radiation therapy (IMRT).Methods Data of 90 patients with histologically proved NSCLC treated with 3DCRT or IMRT between November 2006 and July 2009 were collected.The median radiation dose of 70 Gy (range, 61 - 80 Gy) was delivered with late-course accelerated hyperfractionated radiotherapy (LAHRT).The V5 ,V10 ,V20,V30 and mean lung dose (MLD) were calculated from the dose-volume histogram system.The RP was evaluated according to the common toxicity criteria 3.0(CTC 3.0).Results The range of V5 ,V10 and V20 was 36% - 98%, 27% - 78% and 19% - 54%, respectively, with a median value of 66%, 48% and 31%, respectively.The RP of grade 1,2,3,4 and 5 was observed in 29,23,5,1 and 1 patients.The V5,V10 ,V20, contralateral V10, GTV,PTV, and numbers of fields were all significantly associated with RP of ≥grade 1 (χ2=2.04, 2.05, 2.01, 4.62, 6.50, 5.61, 5.61, and P= 0.044, 0.043, 0.047, 0.030,0.010,0.020,0.020).The V5, V10, V20, V30, and MLD were all significantly associated with RP of ≥ grade 2 (χ2= 2.05,2.20,2.96,4.96,5.20, and P = 0.040,0.030,0.000,0.030,0.020).In Logistic regression analysis, GTV was the only factor significantly associated with RP of ≥ grade 1 (χ2= 4.06, P =0.044).The V20 was the only factor significantly associated with RP of ≥grade 2(χ2=9.61,P=0.002).The RP of ≥grade 2 was significantly increased when V20 was more than 31%.The RP of ≥grade 2 was significantly increased when V20, V10 and V5 were more than 31%, 48% and 66%, respectively.The RP of ≥ grade 2 was significantly increased when V20 was more than 31% and V5 was more than 66%.Conclusions The comprehensive parameters combined with V5, V10 and V20 are effective in predicting RP.