调强适形放射治疗合并慢性阻塞性肺疾病的肺癌患者发生放射性肺炎的临床研究

Clinical Study of Radioactive Pneumonia Following Intensity Modulated Radiation Therapy in Patients with Lung Cancer and Chronic Obstructive Pulmonary Disease

目的探讨合并慢性阻塞性肺疾病(COPD)肺癌患者调强适形放射治疗DVH参数与放射性肺炎发生率的关系。方法分析经我院行调强放射治疗的142例肺癌患者的治疗情况:将患者分为非合并COPD组和合并COPD组,对每例患者肺的剂量体积直方图(DVH)进行评价,计算双肺的V20和双肺平均剂量(MLD)。急性放射性肺炎分级按RTOG急性放射反应分级标准评定。对V20、MLD与发生放射性肺炎的相关关系进行分析比较。结果两组发生≥2级肺急性放射反应的发生率分别为26.2%和31.0%,其中双肺V20>25%或MLD>1500cGy时,合并COPD患者放射性肺炎发生率较非合并COPD患者发生率明显升高,且均有显著统计学意义(P<0.05)。结论在V20>25%或双肺平均剂量(MLD)>1500cGy时,合并COPD的肺癌患者较非合并COPD肺癌患者更易发生放射性肺炎。

Objective To explore the relationships among DVH parameters and radioactive pneumonia after intensity modulated radiation therapy in patients with lung cancer and chronic obstructive pulmonary disease （COPD）. Methods One hundred and forty-two patients who received IMRT for lung cancer were analyzed. Patients were divided into group with COPD and group with no COPD. The dose-volume histogram （DVH） of the lungs was evaluated for all the patients, and canculate the total lung V20 and mean lung dose （MLD）. Acute radioactive pneumonia was classified according to the RTOG scale. The correlation of the total lung V20 and MLD with the radioactive pneumonia was evaluated and compared. Results The incidence of Grade 2 or higher acute radioactive pneumonia was 26.2% for group with no COPD and 31.0% for group with COPD. The incidences of Grade 2 or higher acute radioactive pneumonia of group with COPD were significantly higher than group with no COPD when V20 〉 25% or MLD 〉 1500cGy, and there was statistical difference（P〈 0.05）. Conclusion The group with COPD have higher risk for suffering radioactive pneumonia than the group with no COPD, when V20〉 25% or MLD 〉 1500cGy.