晚期NSCLC三维适形放疗肺低剂量-体积与放射性肺损伤关系初探

The Correlation between Low Dose-Volume and Radiation-Induced Lung Injury with Three-Dimensional Conformal Radiation Therapy in Advanced Non-Small-Cell Lung Cancer

目的:探讨非小细胞肺癌三维适形放疗肺低剂量-体积与放射性肺损伤的相关性。方法:采用三维适形后程加速超分割放射治疗经病理或细胞学证实的非小细胞肺癌患者46例。男性39例,女性7例。Ⅲa期6例,Ⅲb期18例,Ⅳ期22例。鳞癌22例,腺癌24例。初治37例、术后复发9例。单纯放疗8例,放化综合治疗38例。放疗剂量60Gy-79Gy,中位值70Gy。60Gy-69Gy 10例,≥70Gy 36例。剂量-体积(Vx)通过计划系统DVH图计算获得。肺损伤的评估根据CTC3.0标准评价。化疗方案采用紫杉类+铂类一线方案。结果:(1)V5为37.4%-80%,中位值62.O%;V10为27%-66%,中位值43.1%;V20为17%-39%,中位值29.8%;V30为9%-30%,中位21.1%。(2)急性肺损伤:Ⅰ级12例(27%),Ⅱ级18例(40%),Ⅲ级4例(9%),无Ⅳ级急性损伤。晚期肺损伤:Ⅰ级29例(71%),Ⅱ级5例(12%),无Ⅲ级及以上级晚期损伤。(3)V5、V10、V20、V30与大于Ⅱ级的急性放射性肺炎均具有显著相关性。v5、V10还与大于Ⅰ级的急性肺炎有显著相关性。(4)V5、V10与大于Ⅰ级的晚期肺损伤有显著相关性。V5、V10、V20、V30与大于Ⅱ级的晚期肺损伤无显著相关性。(5)在Vx的分层分析中,V5、V10、V20、V30分别大于62%、43%、30%、22%时,大于Ⅱ级急性放射性肺炎发生率显著增高。V20、V30分别大于30%、22%时,发生大于Ⅱ级的晚期肺损伤的几率有统计学差异。(6)性别、年龄、病理、临床分期、处方剂量、GTV体积、PTV体积与各级放射性肺损伤无显著相关性。结论:低剂量一体积参数v5、V10与V20、V30一样,均是Ⅱ级急性放射性肺损伤有效的预测因素,V5、V10可能在预测轻度放射性肺损伤中有着独立的优势。

Objective： To analyze the correlation between low dose-volume and radiation-induced lung injury in patients accepted three-dimensional conformal radiation therapy （3-DCRT） for advanced non-small-cell lung cancer （NSCLC）. Methods： 46 NSCLC patients that were diagnosed by histology or cytology were treated with 3-DCRT from Nov. 2006 to Feb. 2008. 8 patients were treated with radiotherapy alone and 38 patients with radiotherapy plus chemotherapy. The median radiation dose of 70Gy （range 60Gy -79Gy） was delivered by late-course accelerated hyperfractionated radiotherapy （LAHRT）. 10 patients received dose of 60Gy - 69Gy,36 received dose of more than 70Gy. The value of dose - volume was calculated by the DVH system. The radiation - induced lung injury was evaluated according to Common Toxicity Criteria 3.0 （CTC 3.0） Results： The range of VS, V10, V20, V30 was 37.4% - 80%, 27% - 66%, 17% - 39%, 9% - 30% respectively, and the median value was 62.0%, 43.1%, 29.8%, 21.1% respectively. The oeeurrenee of grade Ⅰ ,Ⅱ, Ⅲ acute radiation - induced lung injury was 12（27% ）, 18（40% ）, 4（9% ） respeetively. The oeeurrenee of grade Ⅰ , Ⅱ ehrunie radiation-induced lung injury was 29（71% ）, 5（ 12% ）respectively. V5,V10, V20 ,V30 were all significantly correlated with aeute radiation-induced lung injury over grade Ⅱ. Low dose-volume （V5 ,V10） were significantly correlated with acute radiation-induced lung injury over grade Ⅰ. V5, V10 were significantly correlated with chronic radiation-induced lung injury over grade Ⅰ. The frequency of acute radiationinduced lung injury over grade Ⅱ increased significantly when V5,V10,V20,V30 were more than 62% ,43% ,30% ,22%, respectively. And when V20,V30 were more than 30% ,22%, the probability of chronic radiation-induced lung injury over grade Ⅱ increased significantly. Conclusion： The low dose-volume V5, V10 are the same as V20,V30 which are effective indicators for radiation-induced lung injury. The lower dose-volume V5 ,V10 may be superior to V20 ,V30 in predicting the lower grade radiation-induced lung injury.