胸部放疗放射性肺炎病因学相关因素分析

Analysis of clinical and dosimetric factors associated with radiation pneumonitis in patients with lung cancer or esophageal cancer treated with intensity-modulated radiotherapy

目的:评价在胸部恶性肿瘤的放射治疗中各流行病学因素、治疗因素、放射剂量学因素与放射性肺炎发生的相关性。方法:回顾性分析2007-01-2010-12本中心接受胸部放射治疗的肺癌及食管癌患者共143例。使用CTCAE 3.0标准定义放射性肺炎及其分级,分别记录各患者的性别、年龄、既往手术史、化疗史、放疗史、同步放化疗、长期激素使用史、PTV体积、肺体积、放疗靶区、总剂量、单次剂量、肺平均受量、V5、V10、V20、V30及V40诸因素。分别使用χ2检验、t检验及Logistic回归分析评价各因素与放射性肺炎间的相关性。结果:在143例患者中,共发生放射性肺炎26例(18.18%),其中1、2、3、4级放射性肺炎分别为13例(9.09%)、8例(5.59%)、3例(2.10%)和2例(1.40%)。Logistic回归分析的结果表明既往化疗史、放疗史、同步化疗、ECOG评分、放疗靶区、单次剂量、肺平均受量、V20、V30及V40均与放射性肺炎的发生相关。结论:既往有化疗史者、既往有放疗史者、同步放化疗者、ECOG评分、放疗靶区、单词剂量、肺平均受量、V20、V30或V40均是放射性肺炎发生率显著升高的相关因素。在临床工作中应充分评估需接受胸部放疗患者所具有的相关高危因素,预测可能发生放射性肺炎的风险。

OBJECTIVE： To evaluate the association between the epidemio!ogical, clinical, and dosimetric factors and radiation pneumonitis in patients with lung cancer or esophageal cancer treated with intensity-modulated radiotherapy. METHODS： Totally 143 patients with lung cancer or esophageal cancer treated with intensity-modulated radiotherapy between January 2007 and December 2010 were analyzed. Radiation pneumonitis was defined and graded according to common terminology criteria for adverse events （CTCAE） version 3.0. The epidemiological, clinical, and dosimetric factors were analyzed using Х^2 tests and t test. Univariate and multivariate Logistic regression analyses were used to evaluate the association between related factors and radiation pneumonitis. RESULTS： Among 143 patients, 26 （18.18%） developed radiation pneumonitis. The 1-4 grade radiation pneumonitis were 13（9.09%）,8（5.59%）,3（2.10%） and 2（1.40%）. Logistic regression analyses showed that previous chemotherapy, previous radiation, concurrent chemotherapy, ECOG score, radiation target, single dose, mean lung dose, V20, V30 and V40 were associated with radiation pneumonitis. CONCLUSION： Some clinical and dosimetric factors are the useful indicators to predict radiation pneumonitis in patients with lung cancer or esophageal cancer treated with intensity-modulated radiotherapy.