乳腺癌术后放射性肺损伤的临床分析

Radiation-Induced Lung Injury during Radiotherapy for Breast Carcinoma

目的:分析乳腺癌术后放射治疗引起的肺损伤,对其相关因素进行统计分析。方法:回顾性总结新疆医科大学附属肿瘤医院2007年1月至2010年1月行乳腺癌改良根治或根治术后放射治疗的238例患者的资料,放射治疗计划采用常规+调强,照射计划总量为50Gy。通过患者复查胸片或胸部CT观察放射性肺损伤程度及结合临床症状确定放射性肺损伤的诊断。对238例患者放射治疗后发生放射性肺损伤的患者进行单因素及多因素的统计分析。结果:全组放射性肺损伤发生率为7.6%(18/238),其中未发生放射性肺损伤者220例(92.4%),多元Logistic回归分析显示手术方式、是否合并慢性阻塞性肺病为独立影响因素。结论:手术方式、是否合并慢性阻塞性肺病是影响放射性肺损伤发生的主要因素。

Objective： This work aimed to evaluate the radiotherapy-induced toxicity in the lungs of breast carcinoma patients and to analyze the associated factors. Methods： A retrospective review was performed on data from 238 breast carcinoma patients treated with radiotherapy at the Cancer Hospital of Xinjiang Medical University between January 2007 and January 2010. The radiation dose of the therapy was 50 Gy. Chest X-rays or computed tomography （CT） scans were obtained from all patients. Radiation-induced toxicity was diagnosed by comparing the CT scans and other related clinical symptoms. The degree of radiation-induced toxicity was defined according to the Criteria of Radiation Therapy Oncology Group （RTOG） of the USA, the retrospective clinical data, and other related factors, as well as the physical parameters related to radiation-induced pneumonitis. Univariate and multivariate statistical analyses were conducted. Results： Based on the RTOG criteria, acute post-irradiation lung injury was observed in only 18 of the 238 cases （7.6%）. Conclusion： The mode of surgery and the incidence of chronic obstructive pulmonary disease are significantly associated with pneumonitis in breast carcinoma patients treated with radiotherapy.