局部晚期非小细胞肺癌三维适形放射治疗致放射性肺损伤相关因素探讨

目的 探讨局部晚期非小细胞肺癌患者接受三维适形放射治疗引起放射性肺损伤(radiation-induced lung injury,RILI)的影响因素.方法 选取2014-2015年三维适形放射治疗局部晚期非小细胞肺癌患者64例,采用美国肿瘤放射治疗协作组(radiotherapy oncology group,RTOG)标准评估RILI级别,以放疗结束后3月内发生≥2级RILI作为终点事件,用SPSS 19.0统计软件进行统计学分析,χ2检验进行单因素分析,logistics多元回归模型进行多因素分析.结果 64例中23例发生放射性肺损伤,发生率35.94%;单因素分析发现性别、年龄、病理类型KPS评分、化疗周期数、肿瘤分期及肿瘤直径与RILI发生率无关(P>0.05);而吸烟、慢性阻塞性肺疾病、是否接受同期化疗、放疗总剂量、接受超过某剂量照射的肺体积占全肺总体积的百分比(肺V5、V10、V20、V30)、平均肺受量(mean lung dose,MLD)及计划靶体积(planning target volume,PTV)与RILI发生率有关(P<0.05).多因素分析显示是否接受同期化疗、肺V5、计划靶体积及放疗总剂量是RILI发生率的独立因素.结论 行三维适形放射治疗局部晚期非小细胞肺癌老年患者,若同期化疗、肺V5及放疗总剂量高、计划靶体积大,则需高度重视防治RILI.

The related factors of radiation-induced lung injury caused by 3DCRT for locally advanced non-small cell lung cancer

Objective To analyze the correlative factors of radiation -induced lung injury (RILI) caused by three dimensional conformal radiation therapy (3D-CRT) on locally advanced non-small cell lung cancer patients .Methods Sixty-four patients receiving 3D-CRT from 2014 to 2015 were selected.Radiotherapy oncology group (RTOG) criteria was employed to evaluate the classification of RILI and RILI grade ≥2 served as the endpoint within 3 months after completion of radiotherapy .SPSS 19.0 statistical software was used for sta-tistical analysis,χ2 test was used for univariate analysis ,and Logistics multiple regression model was used for multivariate analysis .Re-sults Among 64 cases,23 (35.94%) cases were radiation-induced lung injury.Univariate analysis revealed that gender ,age,patho-logical type KPS,number of chemotherapy cycles ,tumor stage and tumor diameter were not related to the incidence of RILI (P >0.05),but smoking,chronic obstructive pulmonary disease whether was treated with concurrent chemotherapy ,the total dose,the per-centage of lung volume that exceeds a dose of radiation V 5 ,V10 ,V20 ,V30 ,mean lung dose (MLD) and planning target volume (PTV) were related to the incidence of RILI (P <0.05).Multivariate analysis showed that concurrent chemotherapy ,V5 ,PTV and the total dose were the independent factors of the incidence of RILI .Conclusions The elderly patients with non-small cell lung cancer undergo-ing 3D-CRT with concurrent chemotherapy have the high total dose V 5 and chemotherapy as well as big PTV ,which should be taken more attention to the prevention and treatment of RILI .