放疗前HRCT肺组织异常影像学征象与肺癌三维技术放疗后RP的相关性研究

Relationship of pulmonary abnormalities on high-resolution CT before radiotherapy with radiation pneumonitis after three-dimensional radiotherapy in patients with lung cancer

目的 探讨肺癌患者放疗前HRCT肺组织异常影像学征象与RP发生的相关性.方法 回顾分析2009-2011年间行三维技术放疗的262例肺癌患者放疗前HRCT片和临床资料.异常影像学特征包括网格影、蜂窝改变、磨玻璃影、肺气肿.临床资料包括一般情况、肿瘤因素、治疗因素.Logistic法进行单因素、多因素预测分析.结果 129例出现网格影,其中轻度56例、中度49例、重度24例;37例合并网格状改变;22例合并磨玻璃影.154例出现肺气肿中1级71例、2级55例、3级20例、4级8例.58例发生RP中1～2级39例、3～5级19例.发生RP者中34例疗前HRCT表现网格影,38例表现肺气肿,6例合并蜂窝状改变,2例合并磨玻璃影.单因素分析显示合并慢性阻塞性肺病、FEV1/FCV、V20、MLD、化疗、HRCT表现为肺气肿和网格影与RP发生相关.多因素分析显示同期＋诱导化疗、重度网格影和3级肺气肿是≥3级RP的预测因素.结论 放疗前HRCT肺组织异常影像学征象有助于预测肺癌患者放疗后RP的发生.

Objective To investigate the relationship of pulmonary abnormalities on high-resolution CT （HRCT） before radiotherapy with radiation pneumonitis （RP） after three-dimensional radiotherapy （3DRT） in patients with lung cancer.Methods A retrospective analysis was performed on the HRCT images （before radiotherapy） and clinical data of 262 patients with lung cancer who received 3DRT from January 2009 to April 2011.HRCT showed reticular opacities,honeycomb patterns,ground-glass attenuation,and pulmonary emphysema （PE）.Clinical data included general conditions （age,sex,KPS score,history of smoking,chronic obstructive pulmonary disease （COPD）,interstitial lung disease,and forced expired volume in one second （FEV1）/forced vital capacity （FCV））,disease factors （tumor location,histology,and stage）,and radiotherapy factors （total dose,minimum lethal dose （MLD）,lung V20,surgery,and concurrent chemotherapy）.Univariate and multivariate analyses （logistic regression） were used to identify predictive factors for RP.Results On pre-treatment HRCT,129 patients had reticular opacities,mild in 56 patients,moderate in 49 patients,and severe in 24 patients ;37 patients had honeycomb patterns;22 patients had ground-glass attenuation.A total of 154 patients had PE;grade 1 PE was found in 71 patients,grade 2 PE in 55 patients,grade 3 PE in 20 patients,and grade 4 PE in 8 patients.Fifty-eight patients developed RP;among them,39 patients had grade 1-2 RP,and 19 patients had grade 3-5 RP.In RP patients,34 had reticular opacities,38 had PE,6 had honeycomb patterns,and 2 had ground-glass attenuation,according to the pre-treatment HRCT.Univariate analysis showed that COPD,FEV1/FCV,V20,MLD,chemotherapy,and PE and reticular opacities on HRCT were associated with RP.Multivariate analysis showed that the predictive factors for grade ≥ 3 RP were concurrent and induction chemotherapy,severe reticular opacities,and grade 3 PE.Conclusions Pulmonary abnormalities on HRCT before radiotherapy could help to predict the incidence of RP after thoracic radiotherapy in patients with lung cancer.