非小细胞肺癌三维适形放疗同期化疗发生重度急性放射性肺炎(SARP)相关因素分析

Severe acute radiation pneumonitis after three- dimensional conformal radiotherapy and concurrent chemotherapy in non- small cell lung cancer

目的:探讨三维适形放疗同期化疗的非小细胞肺癌患者发生重度急性放射性肺炎(SARP)的相关因素。方法:回顾分析110例行三维适形放疗同期化疗的非细胞肺癌患者临床资料。对影响SARP发生的临床因素及剂量参数采用单因素和多因素分析,并采用ROC曲线分析各剂量参数的预测价值。结果:SARP发生率为10.91%。原发灶部位及COPD与SARP发生率显著相关(P<0.05)。CTV、CTV接受最大剂量、PTV、PTV接受最大剂量、MLD、V5、V10、V15、V20、V25、V30、V35、V40、V50均与SARP发生呈正相关(P<0.05)。多因素分析结果显示MLD、V5、V10、V20、V30、V35、V40与SARP发生显著相关(P<0.05)。经ROC曲线分析,V5、V20、V30、V35预测SARP发生有统计学意义(P<0.05),界值分别为46.83%、31.56%、21.85%、17.93%。结论:原发灶部位、COPD、MLD、V5、V10、V20、V30、V35、V40是非小细胞肺癌三维适形放疗同期化疗SARP发生的独立影响因子,V5、V20、V30、V35可用于SARP发生的预测,应综合分析各参数优化放疗计划。

Objective：To investigate the relevant factors and predictors of three - dimensional comformal radiother- apy concomitant chemotherapy for non - small cell lung cancer patients with acute severe radiation pneumonitis （SARP）. Methods：A retrospective analysis of the clinical data of 110 patients treated by routine three - dimensional conformal radiotherapy and concurrent chemotherapy for non - cell lung cancer was performed. ROC curve analysis of the predictive value of a dose parameters affect the SARP clinical factors and dose parameters was made by univariate and multivariate analysis. Results： SARP was 10.91%. The primary tumor site and COPD SARP incidence was signif- icantly associated（P 〈 0.05）. CTV, CTV receiving the maximum dose, PTV, PTV received the maximum dose, MLD, V5, V10, V15, V20, V25, V30, V35, V40, V50 and SARP were positive correlated （P 〈 0.05）. Multivariate analysis results showed that the MLD, V5, V10, V20, V30, V35, V40 and SARP incidence was significantly correlated （P 〈 0.05）. ROC emwe analysis, V5 , V20 , V30 , V35 to predict the SARP occurrence of significant （ P 〈 0.05 ） , the critical value were 46.83 % ,31.56% ,21.85 % , 17.93%. Conclusion ：The site of primary tumor, COPD, MLD, V5, V10, V20, V30, V35, V40 non - small cell lung cancer treated with three - dimensional eonformal radiotherapy were independent impact factor of chemotherapy SARP, V5, V20, V30, V35 can be used for SARP forecast comprehensive analysis of various parameters to optimize radiation treatment planning.