高海拔地区三维适形放射治疗所致放射性肺损伤的多因素分析

ANALYSIS ON THE RISK FACTORS OF RADIATION PNEUMONITIS AFTER THREE-DIMENSIONAL CONFORMAL RADIOTHERAPY(3-DCRT)IN LUNG CANCER PATIENTS AT HIGH ALTITUDE

目的探讨在高海拔地区发生放射性肺炎的相关性因素,为临床制定治疗计划提供参考标准。方法 60例未经手术治疗的肺癌患者,采用均数±标准差表示,各组间数值用t检验和单因素方差分析进行统计分析。分组研究肺癌患者临床资料、剂量体积参数及肺功能指标与放射性肺炎的关系。结果①放射性肺损伤2级以上者有19例(31.67%);放疗前合并COPD者有12例(46.67%);②单因素分析有统计学差异的相关因素是放疗前合并有COPD、同步化疗、GTV大小、V30、DLCO(P<0.05)。结论 DLCO在放疗后受损最显著,放射性肺损伤是多因素综合作用的结果,对肺部有COPD的患者应优选治疗方案,且肺V30控制在18%以下。

Objective To evaluate the clinical parameters associated with risk factors of radiation induced lung injury in order to provide the best way for the clinical treatment plan. Methods 60 lung cancer patients without Surgical treatment were selected as subjects. Analyzed the mean -＋ standard deviation and Values among the groups with t test andunivariate analyses . The main research containts were involved clinical data of patients with lung cancer group study, dose volume histograms （ DVH ） and pulmonary function indices with relationship of radiation pncumonitis. Results ① 19 patients were scored as RT- induced pulmonary（ ≥2 grade）among 60. 12 patients with COPD before radiation treatment. ② The univariate analysis revealed that many parameters including COPD, operation, tumor volume, exposed fields, V30 and DLCO） were significantly associated with radiation - induced acute pulmonary toxicity （ P 〈 0.05 ）. Conclusion The radiation - induced acute pulmonary toxicity is result from many factors. DICO is the most significant example. For patients with COPD , V30 should be controlled below 18% in treatment plan.