非小细胞肺癌常规放疗及三维适形放疗引起肺损伤的相关因素分析

Clinical Analysis of radiation Pneumonitis after Radiotherapy of lung Carcinoma

目的:探讨非小细胞肺癌常规放疗及三维适形放疗引起放射性肺炎的相关因素。方法:593例非小细胞肺癌随机常规放疗345例,三维适形放疗248例,通过对常规放疗中不同范围的照射面积、照射剂量以及三维适形放疗过程中不同范围的照射容积、照射剂量分割方法与放射性肺炎的关系进行分析。结果:常规放疗中的照射面积<100cm2发生率10.6%(25/235),>101cm2发生率30%(33/110),χ2=21.49,P<0.001,差异有显著性。照射剂量<70Gy发生率14.1%(45/320),>71Gy发生率68%(13/25),χ2=26.65,P<0.001,差异有显著性。三维适形放疗中单次剂量<5Gy发生率7.8%(6/77),>6Gy发生率19.9%(34/171),χ2=4.88,P<0.05,差异有显著性。放射性肺炎多数是在定期随访检查时发现肺部影像学的异常,而出现症状就诊者为数较少。按SOMA分级,常规放疗1级27例,2级15例,3级以上13例,三维适形放疗1级19例,2级13例,3级以上6例。结论:放射性肺炎的发生,与常规放疗中的照射面积和总剂量密切相关,与三维适形放疗中单次剂量大小密切相关。由于多数患者仅表现影像学异常,因此预见性的防治对减少放射性肺炎的发生尤为重要。

Objoctive To explore the relative factors of radiation pneumonitis （RP）. Methods 593 cases were randomized to conventional radiotherapy （CRT） and three-dimensional confonnal radiatherapy （3-DCRT）. 345 cases were treated by CRT and 248 cases by 3-DCRT. To analyse the effect of the different radiation field-size or the total radiation dose level with CRT and of the different radiation volum or the per fraction dose level with 3-DCRT. Results The incidence of RP in CRT with the field-size 〈 100 cm^2 was 10.6% （25/235） and in those with the field-size 〉 101 cm^2 was 30% （33/110） ,Х^2 = 21, 49,P 〈 0. 001. The total dose 〈70 Gy was 14.1% （45/320）, 〉71 Gy was 68% （13/25） ,Х^2 =26. 65,P 〈0. 001. The incidence of RP in 3-DCRT,The per fraction dose 〈5 Gy was 7.8% （6/77）, 〉6 Gy was 19.9% （34/171） ,Х^2 =4. 88 ,P 〈0.05. Those have statistically significant difference, Conclusion These results suggest that the incidence of radiation pneumonitis was interrelated with the field-size or the total dose in CRT and the perfraction higher dose more often cause RP. It＇s important that we should foreseeable to prevent and cure RP.