Ⅲ＋Ⅳ期非小细胞肺癌三维适形放疗正常肺V5、V10预测放射性肺损伤前瞻性临床研究

Prospective study of lung V5 and Vl0 in predicting radiation-induced lung injury in advanced nonsmall-cell lung cancer treated with three-dimensional conformal radiation therapy

目的探讨非小细胞肺癌三维适形放疗正常肺低剂量体积对放射性肺损伤的预测作用。方法采用三维适形后程加速超分割放疗经病理或细胞学证实的非小细胞肺癌患者100例。Ⅲa期14例，Ⅲb期36例，Ⅳ期50例。鳞癌49例，腺癌48例，腺鳞癌3例。初治79例、术后复发8例，术后残留12例，术后辅助1例。单纯放疗9例，放化疗91例。放疗剂量60—80Gy，60—69Gy24例，≥70Gy76例。化疗方案采用紫杉类＋铂类一线方案。用剂量体积直方图计算正常肺V5、V10、V20、V30和平均肺剂量（MLD）。肺损伤评估根据CTC3．0标准。结果全组V，为37％～98％，中位值65％；V10为27％～78％，中位值47．5％；V20为17％-54％，中位值31％；V30为9％～31％，中位值24％。100例患者中发生放射性肺炎（RP）1级34例，2级27例，3级8例，4级1例，5级1例。75例患者中发生放射性肺纤维化1级46例，2级14例，3级2例。V5、V10、V20、MLD与≥1级RP相关，V5、V20、V30、MLD与≥2级RP相关，V5与≥3级RP相关。V5、V20、V30分别〉65％、31％、24％时发生≥2级RP概率增加，V5、V20分别〉65％、31％时发生≥3级RP概率增加，V20〉31％时发生≥1级RP概率增加。大体肿瘤体积、计划靶体积与≥1级RP、≥2级放射性肺纤维化相关。性别、年龄、临床分期、处方剂量、照射野数目与各级放射性肺损伤无关。结论剂量体积参数V5、V10与RP发生相关，可能成为放射性肺损伤有效的预测因子。

Objective To analyze the low dose-volume associated with radiation-induced lung injury （RILI） in patients with advanced non-small cell lung cancer （NSCLC） treated by three-dimensional eorfforreal radiation therapy （3DCRT）. Methods Data of 100 patients with histologically proved NSCLC treated with 3DCRT or IMRT between November 2006 and January 2009 were collected. Nine patients treated with radiotherapy alone and 91 with radiotherapy combined with chemotherapy. A median dose of 70 Gy （range, 60- 80 Gy） was delivered with late-course accelerated hyperfractionated radiotherapy （LAHRT）. Twentyfour patients received dose of 61 - 69 Gy and 76 received more than 70 Gy. The V5 ,V10 ,V20 ,V30 and mean lung dose （MLD） were calculated from the dose volume histogram system. The RILI was evaluated according to Common Toxicity Criteria 3.0 （ CTC 3.0）. Results The range of V5, V10, V20 and V30 was 37 % - 98 % , 27% -78%, 17% -54% and 9% -31%, respectively, with a median value of 65%, 47.5%, 31% and 24%, respectively. The acute RILI of grade 1,2, 3,4 and 5 was observed in 34, 27, 8, 1 and 1 patients, respectively. The chronic RILI of grade 1,2 and 3 was observed in 46, 14 and 2 patients, respectively. V5, V10, V20 and MLD were significantly correlated with acute RILI of ≥grade 1. V5, V20, V30 and MLD were significantly correlated with acute RILl of ≥ grade 2. The acute RILl of ≥ grade 2 was significantly increased when V5, V20 and V30 were more than 65%, 31% and 24%, respectively. The acute RILI of ≥ grade 3 was significantly increased when Vs was more than 65%. The acute RILl of 1〉 grade 1 was significantly increased when V2o was more than 31%. The gross tumor volume and planning target volume were significantly correlated with the acute RILI of t〉 grade 1 and chronic RILI of ≥ grade 2. Conclusions The dose-volume V5 and Vl0 are effective in predicting RILI.