62例局部晚期NSCLC三维适形放射治疗中放射性肺炎相关因素分析

Correlative factor analysis of radiation pneumonitis in 62 iocally advanced NSCLC cases treated with 3DCRT

目的:探讨接受三维适形放射治疗局部晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者发生放射性肺炎的相关因素。方法:62例不能手术切除局部晚期NSCLC患者放疗前1周行肺功能检测,分析患者性别、年龄、临床分期、病理类型、病变部位、同步化疗、吸烟状况、合并慢性阻塞性肺病与否、肿瘤位置、肿瘤体积和剂量参数V10、V20、V30以及肺功能指标与放射性肺炎的关系。结果:62例患者中11例发生放射性肺炎,其中3例发生于放疗中,8例发生于放疗后1个月内。单因素分析有统计学差异的相关因素为肺功能状态、肿瘤体积、肺剂量体积参数(P=0.002,P=0.000,P=0.032);经过Logistic回归模型多因素分析,放疗前合并重度慢性阻塞性肺病、病变位于肺下叶、肿瘤直径>5cm以及V30>25%为放射性肺损伤发生的显著相关因素(P=0.047,P=0.035,P=0.040和0.002)。结论:放射性肺损伤是多因素综合影响结果,对肺部有慢性疾病患者应优选治疗方案,且控制肺V30<25%。

Objective： To analyze the correlative factors as predictors of acute radiation pneumonitis in the treatment of three dimensional conformal radiotherapy（3DCRT） for locally advanced NSCLC patients.Methods： Sixty two unresectable locally advanced NSCLC patients were received pulmonary function test one week before radiotherapy,and analyze the relationship between radiation pneumonitis and sex,age,clinical stage,pathologic type,lesion location,concurrent chemotherapy,smoking,tumor volume,COPD,V10,V20,V30 and pulmonary function.Results： Eleven patients were found with radiation pneumonitis,inclding 3 patients who were found during treatment and 8 patients were found in the first month after treatment.Single factor analysis： Relative factors with statistic difference are： COPD,GTV volume,DVH,DLco（P=0.002,P=0,P=0.032）.By binary Logistic analysis,COPD and V3025% were independent factors（P=0.047,P=0.035,P=0.040 and 0.002）.Conclusion： Radiation pneumonitis was affected by multiple factors.Patients with COPD or abnormal lung function should be treated with optimal plan,and V3025%.