肺癌三维适形及调强放疗诱导肺损伤与剂量体积直方图参数的相关性

Correlations between dose-volume histogram parameters and radiation-induced lung injury for lung cancer patients treated with three-dimensional conformal radiotherapy and intensity-modulated radiotherapy

目的探讨肺癌三维适形放疗（3D-CRT）和调强放疗（IMRT）诱导肺损伤（RILI）与剂量体积直方图（DVH）参数的关系及两种放疗计划的差异。方法 151例肺癌患者分别接受3D-CRT（n=90）和IMRT（n=61）,均给予根治性放疗剂量,采用传统分割照射（1.8~2.0Gy/次,1次/天,5次/周）,中位剂量60.0Gy。比较两组发生RILI的差异,并分析两组发生≥2级RILI与DVH参数的关系。结果 3D-CRT组≥2级RILI发生率为17.8%,略低于IMRT组的24.6%;≥3级RILI发生率为8.9%,略高于IMRT组的3.3%,差异无统计学意义（P〉0.05）。单因素分析显示,3D-CRT组V20可增加≥2级RILI的发生风险（OR=3.780,P=0.030）;IMRT组V5、V10、V13、V20和平均照射剂量均可增加≥2级RILI的发生风险（OR：3.575~6.286,P：0.003~0.045）。多因素分析显示V20是RILI的独立危险因素。结论 3D-CRT和IMRT对肺癌患者≥2级RILI的发生率影响不明显,但RILI的发生风险均与V20相关。

Objective To investigate the effect of three-dimensional conforrnal radiotherapy （3D-CRT） and intensitymodulated radiotherapy（IMRT） on radiation-induced lung injury（RILI） and their relations with parameters of dose volume histograms （DVH）. Methods One hundred and fifty-one cases of locally advanced lung cancer patients treated with chemoradiotherapy from sin- gle clinical center were enrolled retrospectively, including 90 cases of 3D-CRT and 61 cases of IMRT. All patients were treated with radical radiotherapy dose, 1.8-2. 0Gy per fraction, 5 fracions one week, and the median prescribed close was 60. 0Gy. RILI was defined according to the National Cancer Institute Common Toxicity Criteria, version 3. 0. The incidence of RILI in two groups was calcu- lated and its association with the parameters of DVH were analyzed. Results The incidence of RILI（ ≥ grade 2） in 3D-CRT group was lower than that in IMRT group（ 17.8% vs. 24. 6%） ; on the contrary, the incidence of RILI（ ≥grade 3） in 3D-CRT group was higher than that in IMRT group（8. 9% vs. 3.3%）. However, there was no statistically significant differenee（P〉0. 05）. In 3D-CRT group, V20 would increase the risk of RILI（ OR = 3.780, P = 0. 030）, whereas, in IMRT group, V5, V10, V13, V20 and mean lung dose would increase the risk of the RILI（ OR = 3.575-6. 286, P= 0. 003-0. 045 ） by univariate analysis. Multivariate analysis confirmed V20 was an independent risk factor. Conclusion 3D-CRT and IMRT seemed to have no significant effect on RILI（≥grade 2）, and V20 is tightly correlated with RILI.