肺癌放疗所致放射性肺损伤的相关因素分析

Analysis of radiation-induced lung injury after lung cancer radiotherapy

目的:分析肺癌三维适形放疗中与放射性肺损伤相关的各种因素,并探讨预测价值。方法:对70例接受三维适形放疗的非小细胞肺癌患者根据是否发生放射性肺损伤进行回顾性对照研究,将放射性肺损伤相关临床因素大致分为患者一般情况与系统病变、肿瘤自身因素、放疗除外其他治疗和放疗相关因素4类,并进行单因素和多因素分析。结果:单因素分析显示:仅大体肿瘤体积(P=0.009)和部分剂量体积参数如患者平均肺受量(P=0.017)、患肺V20(P=0.036)和全肺平均肺受量(P=0.034)对放射性肺损伤有显著影响,而其他因素影响不显著。多因素分析显示:剂量体积参数中仅平均肺受量(P=0.019)为放射性肺损伤独立相关因素。结论:参考剂量体积参数和大体肿瘤体积有助于预测放射性肺损伤的发生。

OBJECTIVE：To evaluate the clinical parameters for association with risk of radiation-induced lung injury in patients after three-dimensional （3D） conformal radiation therapy for lung cancer. METHODS： Seventy patients treated for non-small cell lung cancer were retrospectively evaluated, which were divided into two arms according to whether radiation-induced lung injury developed. The clinical parameters related to radiation-induced lung injury were divided into four groups： general state of health and systematic process, tumor-related factors, treatment except radiotherapy, radiotherapy-related factors. Univariate and multivariate analyses were performed to evaluate the data for association between clinical parameters and radiation-induced lung injury. RESULTS： In univariate analyses, GTV （P=0.009）, ipsilateral lung MLD （P=0.017）, ipsilateral lung V20 （P=0.036） and total lung MLD （P=0.034） were associated with radiation-induced lung injury. In multivariate analysis, ipsilateral lung MLD was the only variable associated with radiation-induced lung injury,P=0.019. CONCLUSIONS： GTV, ipsilateral lung MLD, ipsilateral lung V20 and total lung MLD are useful indicators of risk for development of radiation-induced lung injury after 3D conformal radiation therapy in patients with lung cancer.