食道癌三维适形放疗致放射性肺炎相关因素分析

Analysis of factors of radiation pneumonitis with 3D conformal radiotherapy for esophageal cancer patients

目的分析接受三维适形放疗食道癌患者的放疗计划中各参数指标与放射性肺炎发生的关系。方法回顾接受放射治疗的103例食道癌患者的临床资料,包括患者体力状况评分、吸烟情况、肺部合并症和肿瘤的位置、临床分期、化疗情况、放疗方式等;收集所有患者三维适形治疗计划的剂量体积直方图(DVH)中各参数指标,包括不同剂量(Gy)照射的肺体积占全肺体积的百分比(V_(dose):V_5、V_(10)、V_(13)、V_(15)、V_(20)、V_(25)、V_(30)、V_(35)、V_(40)、V_(45))、全肺平均剂量(LMD)、大体肿瘤靶区(GTV)、两肺容积等。分析临床和放疗参数指标与放射性肺炎发生的关系。结果103例中25例发生放射性肺炎,其中6例发生于放射治疗中,19例发生于放疗后4月内。单因素分析显示,在有与无放射性肺炎发生的患者之间,两肺V_5、V_(10)、V_(13)、V_(15)、V_(20)、V_(25)、V_(30)及LMD、肺容积比较有统计学差异(P<0.05);而临床指标的比较无统计学差异(P>0.05)。Logistic多元回归分析未发现与放射性肺炎发生相关的因素(P>0.05)。结论评估三维适形食道癌放射治疗计划时,要充分考虑两肺V_5、V_(10)、V_(13)、V_(15)、V_(20)、V_(25)、V_(30)及LMD、肺容积等指标。

Objective To evaluate the correlation between clinical and dose-volume histogram pneumonitis in esophageal cancer patients treated with 3D conformal radiotherapy. Methods based factors and radiation The clinical data of 103 esophageal cancer patients who received radiotherapy were retrospectively reviewed, including performance status scoring, smoking, pulmonary comorbidity, tumor location, clinical staging, chemotherapy and radiotherapy mode. The dose-volume histogram based parameters including percent of lung receiving 5, 10, 13, 15, 20, 25, 30, 35, 40, and 45 Gy （V5、V10、V13、V15、V20、V25、V30、V35、V40、and V45、, respectively）, lung mean dose （LMD） , gross target volume（GTV）and lung volume were analysed. The correlation between clinical and radiotherapy parameters and radiation pneumonitis was explored. Results Among the 103 patients, 25 experienced radiation pneumonitis. Six took place during the radiotherapy, and the other 19 occurred within 4 months after radiotherapy. It was revealed by univariate analysis that there were significant differences in V5、V10、V13、V15、V20、V25、V30、, LMD and lung volume between those with radiation pneumonitis and those without（P 〈0.05）. However, there was no significant difference in clinical parameters（P 〉0.05）. No factors were found to be associated with radiation pneumonitis by Logistic analysis （P 〉 0.05）. Conclusion Great importance should be attached to parameters such as V5、V10、V13、V15、V20、V25、V30、, LMD and lung volume when 3D eonformal radiotherapy for esophageal cancer patients was evaluated.