肺癌、纵隔肿瘤及食管癌放疗后放射性肺炎发生因素的对比研究

 目的　对肺癌（肺靶区）与纵隔肿瘤及食管癌（纵隔靶区）三维适形放疗中放射性肺炎（RP）发生的影响因素及剂量体积直方图（DVH）参数进行对比研究。方法　回顾性分析接受放射治疗的肺癌、纵隔肿瘤及食管癌患者83例的临床资料，采用χ2 检验对临床因素（性别、年龄、肿瘤部位、分期、化疗）与RP发生的相关性进行分析；分别对两靶区的DVH参数与RP的发生进行相关性分析；用t检验对肺靶区与纵隔靶区DVH参数进行比较。结果　≥2级 RP 发生率为36.5 %（31／81）。各临床因素与≥2级RP发生无关（χ2 值分别为0.377、0.215、0.018、0.717、0.215，均P＞0.05）。两靶区的DVH参数中，V5、V10、V20、V30、全肺平均剂量（MLD）与RP的发生均具有明显相关性。两靶区发生RP的患者V5（50.9±17.8）%、（69.9±20.4）%]（t＝2.745，P＜0.05）、V10（38.6±15.2）%、（53.5±18.8）%]（t＝2.434，P＜0.05）差异均有统计学意义，而V20（t＝0.388，P＞0.05）、V30（t＝0.005，P＞0.05）及MLD（t＝0.138，P＞0.05）差异均无统计学意义。两靶区未发生RP患者的DVH参数t检验后得到类似结果。结论　在肺靶区、纵隔靶区的放疗中，RP的发生与DVH参数密切相关，尤其是V20、V30及MLD对RP的发生有重要的影响。

Comparative study on radiation pneumonitis occurred in lung cancer with mediastinal tumors and esophageal after radiotherapy

Objective　A comparative study of clinical factors and dose-volume histogram (DVH) parameters on the impact of radiation pneumonitis occurred in the three-dimensional conformal radiotherapy of lung cancer (lung target )and mediastinal tumors and esophageal (mediastinal target). Methods　Review 83 cases lung cancer, mediastinal tumors and esophageal patients, and analyzed with chi-square tests on the correlation of the clinical factors (gender, age, tumor location, stage, chemotherapy) with radiation pneumonitis; have relevance analysis between the DVH parameters of two targets and radiation pneumonitis; lung target and mediastinal target volume DVH parameters compared to the t-test. Results　≥2 radiation pneumonitis was 36.5 %. ≥2 radiation pneumonitis occurred in various clinical factors had no significant effect. DVH parameters of the two targets, V5, V10, V20, V30, whole lung dose (MLD) were significantly related to RP. Two targets of RP patients V5 (50.9±17.8) %, (69.9±20.4) %], V10 (38.6±15.2) %, (53.5±18.8) %] were statistically significant by t-test (t = 2.434, P < 0.05), while V20 (t = 0.388, P > 0.05), V30 (t = 0.005, P > 0.05) and MLD (t = 0.138, P >0.05) were no significant difference (P > 0.05), so the same results with the two targets of patients without RP obtained. Conclusion　In the lung target and mediastinal target of radiotherapy radiation pneumonitis is related with DVH parameters, especially V20, V30 and MLD impact on the occurrence of RP..