胸部肿瘤三维适形放疗所致放射性肺炎影像学表现及病因分析

Analysis of clinical factors and radiology manifestations of radiation pneumonitis with 3D conformal radiotherapy for chest tumors patients

目的:探讨胸部肿瘤三维适形放疗(3D-CRT)所致放射性肺炎(RP)的影像学表现及发生的相关因素。方法:对28例三维适形放疗所致RP患者胸部影像学征象进行评定,并通过临床观察对RP的相关因素进行分析。结果:97例胸部肿瘤放疗患者中发生RP 28例,发生率28.87%。在各临床指标中,吸烟患者、肿瘤位于双肺上叶的患者发生概率较高。在剂量学指标中,单因素分析显示受到20、30、40Gy剂量照射的肺体积占全肺总体积的百分比(V20、V30、V40)、全肺平均剂量(MLD)与RP相关。结论:CT诊断RP较X线敏感,有特征表现,而且对肺炎的不同时期可作出正确判断。肺炎的发生因素,除放疗技术外,个人体质、吸烟、手术等都有影响。

Objective： To analyze the related relatively clinical factor and radiology manifestations of radiation pneumonia. Methods：To assess the radiology manifestations in 38 cases suffered from RP in 181 patients who received 3D conformal radiotherapy for chest tumors and analyze relative factors of radiation pneumonitis（RP）. Results：Among the 181 patients,38 experienced radiation pneumonitis. The incidence of radiation pneumonitis was 20.99 %. In the clinical indicators, smoking patients, upper lobe location of the tumor in patients have higher risk. In the dosimetry indicators, univariate analysis showed that V20, V30, V40, MLD were related with radiation pneumonitis. Conclusion：CT isbetter than X-ray for early diagnosis and stage of RP. The relatively clinical factor of radiation pneumonia include pulmonary comorbidity, tumor location, clinical staging, chemotherapy and radiotherapy mode.