摘要
目的 利用剂量体积直方图(DVH)参数建立Logistic剂量反应及Lyman-Kutcher-Burman正常组织并发症概率(LKB-NTCP)模型,并评估其对非小细胞肺癌同期放化疗后重度急性放射性肺炎(SARP)的预测价值.方法 搜集2006-2010年间行三维适形放疗同期化疗的147例非小细胞肺癌患者资料.按美国RTOG毒性评价标准定义超过3级的ARP为SARP.根据DVH剂量学信息建立Logistic剂量反应模型和LKB-NTCP模型.结果 SARP发生率为9.5%(14/147).Logistic剂量反应模型参数:常数b0=-6.66、b1=0.252,TD50=26.43 Gy,γ50=1.67;模型曲线在17 Gy以下相对平坦,17~18 Gy处变为陡峭,SARP风险增大.LKB-NTCP模型参数:体积效应因子n=0.87±0.40,曲线斜率倒数m=0.27 ±0.10,TD50(1)=(29.5±8.0)Gy;Logistic回归及ROC分析均发现此参数下计算出NTCP值对SARP有良好预测价值(P=0.013、0.019).结论 NTCP值对SARP的预测价值优于简单剂量参数,2个模型曲线均提示最大限制剂量在约17 Gy.
Objective To establish the Logistic dose response model and Lyman-Kutcher-Burman (LKB)-normal tissue complication probability (NTCP) model using dose-volume histogram (DVH) parameters and to evaluate their predictive values for severe acute radiation pneumonitis (SARP) in patients with non-small cell lung cancer (NSCLC) after concurrent chemotherapy and three-dimensional conformal radiotherapy (3DCRT).Methods The clinical data of 147 NSCLC patients who were treated with concurrent chemotherapy and 3DCRT from 2006 to 2010 were collected.According to RTOG criteria,grade 3 or even severer acute radiation pneumonitis was defined as SARP.The Logistic dose response model and LKB-NTCP model were established according to DVH dosimetric information.Results The incidence of SARP was 9.5% (14/147).The best-fit parameter values for Logistic dose response model were shown as follows:constant b0 =-6.66;constant b1 =0.252;TD50 =26.43 Gy;γ50 =1.67.The fit curve was relatively flat when the maximum limit dose (MLD) was 〈 17 Gy,and it became sharper when the MLD was 17-18 Gy,which implied that the risk of SARP increased.The best-fit parameter values for LKB-NTCP model were shown as follows:volume factor n=0.87 ± 0.40;slope factor m =0.27 ±0.10;TD50(1) =(29.5 ±8.0)Gy.The Logistic regression analysis and receiver operating characteristic (ROC) analysis showed that the NTCP value calculated using the parameter values had a good predictive value for SARP (Logistic regression:P =0.013 ;area under the ROC curve:0.707,P =0.019).Conclusions The predictive value of NTCP for SARP is better than simple dose parameters.The two model curves suggest that MLD is above 17 Gy.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2013年第6期455-459,共5页
Chinese Journal of Radiation Oncology
基金
国家自然科学基金项目(81172126)
关键词
癌
非小细胞肺
同期放化疗法
放射性肺损伤
预测模型
Keywords:Carcinoma, non-small cell lung/concurrent radio-chemotherapy
Radiation induced lung injury
Forecasting model