非小细胞肺癌患者放疗前后肺功能变化及其与放射性肺炎的相关性

The changes of pulmonary function before and after radiotherapy in patients with non-small-cell lung cancer and its correlation with radiation pneumonitis

目的探讨适形调强放射治疗(IMRT)对非小细胞肺癌(NSCLC)患者肺功能指标的影响,分析肺功能指标与放射性肺炎(RP)发生率、剂量体积直方图(DVH)参数与RP发生程度的关系。方法纳入未经手术首次放疗的患者52例,卡氏评分(KPS)大于或等于80分。检测IMRT前、结束时、结束第1、3个月用力肺活量(FVC),第一秒用力呼气容积(FEV1.0)和一氧化碳弥散量(DLCO)变化。观察RP发生率和程度,在DVH中得出V20、V30值。采用Spearman相关分析肺功能指标与RP发生率,V20、V30与RP发生程度的关系。结果 52例患者有49例获得随访,随访率94.20%。49例患者中,剔除2例出现肺内复发或肺转移的患者,共47例纳入最终研究。其中RP 18例,RP发生率为38.30%。第3个月,FEV1.0和DLCO均较放疗前明显下降(P<0.05),FVC无明显变化(P>0.05)。相关分析显示,FVC、FEV1.0和DLCO与RP的发生均呈正相关(r=0.451、0.405、0.635,P<0.05);另外V20、V30与RP的程度呈正相关(r=0.689、0.725,P<0.05)。结论 NSCLC V20、V30值越大,RP越严重,可作为预测RP程度的指标。

Objective To explore the effects of intensity modulated radiation therapy （IMRT） on lung function in patients with non small cell lung cancer （NSCLC） ,analyze relationship between lung function indexes and radiation pneumonitis （RP） incidence rate ,dose volume histogram （DVH） parameters and incidence degree of RP .Methods 52 patients without operation first radiother‐apy patients were included ,all with Karnofsky score （KPS） ≥ 80 points .Detection of IMRT ,before the end of the end ,first months ,third months of forced vital capacity （FVC） ,forced expiratory volume in one second （FEV1 .0） and diffusion capacity of carbon monoxide （DLCO） change were conducted .The incidence and degree of RP were measured ,and got the V20 and V30 value in DVH .By Spearman correlation analysis ,the relationship between pulmonary function index and the incidence of RP ,V20 ,V30 and RP was analyzed .Results Among the 52 patients ,49 patients were followed up ,the follow -up rate was 94 .2% .In the 49 pa‐tients ,two cases were excluded in the lung recurrence or lung metastasis patients ,thus a total of 47 patients were included in the fi‐nal study .There were 18 cases of RP ,the incidence of RP was 38 .30% .In the third month ,FEV1 .0 and DLCO were significantly decreased than that before radiotherapy （P〈0 .05） ,FVC had no significant change （P〉0 .05） .Correlation analysis showed that FVC ,FEV1 .0 and DLCO and RP were positively correlated （r=0 .451 ,0 .405 ,0 .635 ,P〈0 .05）;and V20 ,V30 and RP was posi‐tively correlated （r=0 .689 ,0 .725 ,P〈0 .05） .Conclusion the larger the NSCLCV20 ,V30 value ,the more serious the RP would be ,thus they could be predictor of RP degree .