62例非小细胞肺癌三维适形放疗后放射性肺炎与剂量体积直方图分析

The Analysis of Relationship Between Radiation Pneumonuitis and DVH for NSCLC Treated with 3DCRT.

目的本研究的目的是分析放射性肺炎(RP)和三维适形放疗(3-DCRT)非小细胞肺癌(NSCLC)的剂量体积直方图(DVH)的参数之间的关系。方法1998年1月～2005年12月我院收治的接受全程三维适形放疗的62例病人,所有病人都接受了全程三维适形放疗,每天1次,每周5次,每次分割剂量2Gy,总剂量为60～70Gy,放射性肺炎分级标准为RTOG/EORTC,采用回归分析放射性肺炎和剂量-体积直方图参数如平均肺体积(MLD)、V20、V30以及正常组织并发症概率(NTCP)之间的关系。另外还考虑了临床影响因素如年龄、性别、肿瘤部位、KPS评分和附加化疗等因素的影响。结果30例(48%)为0～1级(0级:12%,1级:36%)、32例(52%)2～3级(2级:47%,3级:5%)。在回归分析中,所有DVH参数都与放射性肺炎有关(P0.004～0.007)。其中影响最大的为NTCP和V30。结论NTCP和V30是预测接受了三维适形放疗的非小细胞肺癌患放射性肺炎的最好因素。

Objective To determine the relation between the incidence of radiation pneumonitis （RP） and available parameters from a dose- volume histogram （DVH） in patients with non -small cell lung cancer （NSCLC） who underwent three -dimensional conformal radiotherapy treatment. Methods Between January 1998 and December 2005 our hospital, 62 patients with NSCLC were treated using three -dimensional conformal radiotherapy （3D CRT）. All patients were treated 5 days per week with daily fractionation of 2 Gy to total dose of 60 - 70 Gy. All patients were available for analysis for symptomatic RP. Radiation pneumonitis was graded according to the RTOG/EORTC morbidity scoring classification. Logistic regression analysis was performed to test the association between RP and the fol- lowing DVH parameters： mean lung dose （MLD） , volume of lung receiving 20 Gy （ V20 ） and 30 Gy （V30） and normal tissue complica- tion probability （NTCP）. Additionally, correlation of the following clinical factors such as： age, sex, tumor site, performance status （KPS） , and additional therapy （chemotherapy） with incidence of the RP were performed. Results Thirty out of 62 patients （48%） developed RP grade 0 or 1 （0 grade：12% , 1 grade：36% ） and 32 （52%） grade 2 or 3 （2 grade：47% , 3 grade：5% ）. In the logistic re- gression analysis, all DVH parameters were associated with RP （ p in range from 0. 004 to 0. 007 ）. The strongest association was observed for NTCP and V30 （ P = 0. 004）. Conclusion NTCP and V30 parameters were the best predictors of symptomatic radiation pneumonitis for patients after three - dimensional conformal radiotherapy of non - small cell lung cancer.