非小细胞肺癌同期放化疗后重度急性放射性肺炎的预测因素

目的 评价剂量体积直方图参数及临床因素对非细胞肺癌三维适形放疗同期化疗后急性重度放射性肺炎(SARP)的预测价值。方法 回顾分析2006-2010年行三维适形放疗同期化疗的非小细胞肺癌 147例病例资料。对有无SARP的剂量学参数行成组t检验,对有差异的和临床因素行Logistic法多因素预测分析。用受试者工作特征(ROC)曲线分析各剂量学因素的预测价值,Pearson法分析剂量学数据间相关性并从剂量学参数中提取有代表性因子。结果 全组患者SARP发生率为9.5%。平均肺剂量(MLD)、V₂₀、V₃₀、V₄₀、V₅₀与SARP发生相关(χ²=4.87~6.84,P=0.009~0.025)。控制SARP发生率≤5%时的界值分别为MLD≤16.77 Gy,V₂₀≤34.15%, V₃₀≤23.62%, V₄₀≤18.57%, V₅₀≤13.02%, 其敏感性、特异性、ROC曲线下面积分别为78.0%、48.1%、0.678,42.9%、82.0%、0.661,78.6%、52.9%、0.667,71.4%、61.7%、0.677,57.1%、67.7%、0.651。因子分析显示可考虑选取MLD、V₂₀、V₃₀中的1个或2个,V₄₀、V₅₀中的1个用于预测SARP。肿瘤位于右中下肺者SARP发生率高于其他部位(22.2%∶6.7%,χ²=6.19,P=0.023)。结论 MLD、V₂₀、V₃₀、V₄₀、V₅₀可用于放射性肺炎预测,但单个预测价值不佳,要多种参数联合使用。肿瘤位于右肺中下叶者放疗后发生SARP危险性较肿瘤位于其他部位者高。

Severe acute radiation pneumonitis after concurrent chemoradiotherapy in non-small cell lung cancer

Objective The study is to investigate the predictive values of dosimetric parameters and patient related factors in severe acute radiation pneumonitis (SARP) after concurrent chemoradiotherapy in non-small cell lung cancer (NSCLC). Methods In all, 147 NSCLC patients treated with concurrent chemotherapy and 3DCRT between 2006 and 2010 was collected. Independent sample t test was used to compare parameter values between patients with SARP and those without SARP. Logistic regression was used to identify significant determined factor. Predictive value of each parameter was tested by ROC analysis. Pearson correlation was used to analyze correlations between parameters. Represent factors were identified by factor analysis. Results The incidence of SARP was 9.5%(14/147). The means lung dose (MLD), V₂₀, V₃₀, V₄₀, and V₅₀(χ²=4.87－6.84,P=0.009－0.025, respectively) were determining factors for SARP. Our datasets shows that for SARP<5%, MLD, V₂₀, V₃₀, V₄₀ and V₅₀ should be ≤16.77 Gy, V₂₀≤34.15%,.V₃₀≤23.62%,.V₄₀≤18.57%, V₅₀≤13.02%. ROC analysis show that areas under MLD, V₂₀, V₃₀, V₄₀ and V₅₀ curves was corresponding to 0.678, 0.661, 0.667, 0.677, and 0.651, respectively. In addition, the sensitivity and specificity of each parameter at cutoff values are:78.0% and 48.1% for MLD;42.9% and 82.0% for V₂₀;78.6% and 52.9% for V₃₀;71.4% and 61.7% for V₄₀, and 57.1% and 67.7% for V₅₀. Factor analysis suggest that we can choose 1 or 2 parameters from MLD, V₂₀, or V₃₀, and another from V₄₀ or V₅₀ for predicting. The incidence of SARP was greater in patients withtumors in right lower lung than other locations (22.2% vs 6.7%,χ²=6.19,P=0.023). ConclusionsThe MLD, V₂₀, V₃₀, V₄₀ and V₅₀ are determining factors for SARP. As predictive value of each parameter alone is relatively week, using two or more parameters to predict SARP is recommended.