肺癌放疗中V_(20)和V_(30)预测肺急性放射反应分级价值的研究

Value of V_(20) and V_(30) parameters for predicting acute radiation lung toxicity after 3D radiotherapy for lung cancer

目的:通过对V20、V30和肺急性放射反应分级的相关性评价,探讨其在肺癌三维适形放疗(3D-CRT)中预测肺急性放射反应分级的价值。方法:50例肺癌患者均有完整的3D-CRT治疗计划,对每例患者肺的剂量体积直方图(DVH)进行评价,分别计算全肺及患侧肺的V20和V30。肺急性放射反应分级按RTOG急性放射反应分级标准评定。对V20、V30(包括单侧肺的V20、V30)和肺急性放射反应分级的相关关系进行分析比较。结果:50例肺急性放射反应分级:0级16例,1级19例,2级14例,3级1例。全组患者≥2级肺急性放射反应的发生率为30%。全肺V20≤30%和>30%两组发生≥2级肺急性放射反应的发生率分别为18.4%和66.7%,全肺V30≤20%和>20%两组发生≥2级肺急性放射反应的发生率分别为14.3%和66.7%,V20、V30和肺急性放射反应分级显著相关,P<0.001。多因素分析结果显示,全肺V20、全肺V30、患侧肺V20和患侧肺V30均为发生≥2级肺急性放射反应的独立相关因素。结论:V20和V30均可预测肺急性放射反应的程度,并可作为评价治疗计划的剂量学参数。

OBJECTIVE： To explore the value of V20 and V30 parameters for predicting acute radiation lung toxicity after 3-dimensional conformal radiation therapy（3D-CRT） for lung cancer by evaluating the correlation of V20 and V30 parameters with acute radiation lung toxicity. METHODS.. Fifty patients who received 3D-CRT for lung cancer were retrospectively analyzed. The dose-volume histogram （DVH） of the lungs was evaluated for all the patients. Acute radiation lung toxicity was classified according to the RTOG scale. The correlation of the total lung V20 and V30 parameters （including ipsilateral V20 and V30 ） with the acute radiation lung toxicity was evaluated. RESULTS.. The acute radiation lung toxicity developed in 50 patients as follows： Grade 0 in 16, Grade 1 in 19, Grade 2 in 14, Grade 3 in 1. The total incidence of Grade 2 or higher acute radiation lung toxicity was 30 % for all 50 patients . The incidences of Grade 2 or higher acute radiation lung toxicity were 18. 4% and 66.7% for groups of V20 ≤30% and V20 〉 30% respectively; 14. 3% and 66.7% for groups of V30≤20% and V30〉20%, respectively. There were significant differences in the incidences of Grade 2 or higher acute radiation lung toxicity between the two groups of V20≤30% and V20〉30% orV30≤20% andV30〉20%, P〈0.001. Multivariate analysis revealed the V20 and V30 （including ipsilateral V20 and V30 ） parameters were the independent predictors of acute radiation lung toxicity. CONCLUSION： The V20 and V30 parameters may be useful in predicting acute radiation lung toxicity incidence or grade and evaluating treatment plans.