非小细胞肺癌患者放疗导致放射性肺损伤的相关因素分析

Analysis of related factors of radiation-induced lung injury caused by radiotherapy in patients with non-small cell lung cancer

目的探讨非小细胞肺癌患者三维适形放疗中各种因素对放射性肺损伤的预测价值。方法非小细胞肺癌患者118例采用三维适形方案放疗,6 MV X线,每次1.8~2 Gy,每周5次,保持总剂量为50 Gy以上。收集118例患者的相关临床因素,观察肿瘤的生物学因素以及肿瘤治疗的方案(包括放疗及其他治疗方式)等对放疗性肺损伤的影响,并对此因素进行单因素和多因素分析。结果发生肺损伤103例,发生率87.3%。单因素分析显示,仅大体肿瘤体积和部分剂量体积参数如患者的平均肺剂量、患肺V20和全肺平均肺剂量对放射性肺损伤有影响(P<0.01),而其他因素影响不显著。多因素分析显示,剂量体积参数中仅平均肺剂量为放射性肺损伤独立相关因素(P<0.05)。结论大体肿瘤体积、平均肺剂量、患肺V20和全肺平均肺剂量是非小细胞肺癌患者三维适形放疗后发生放射性肺损伤的危险因素。

Objective To explore the predictive value of various factors in patients after three-di-mensional（3D）conformal radiation therapy for non-small cell lung cancer（NSCLC）.Methods The clini-cal parameters of 118 NSCLC patients,including general data,dosimetry,tumor biological factors,and treatment plan,were retrospectively evaluated.Univariate and multivariate analyses were performed to eval-uate the data for association between clinical parameters and radiation-induced lung injury.Results In the univariate analyses,gross tumor volume,mean ipsilateral lung dose,ipsilateral lung V20 and mean total lung dose were associated with radiation-induced lung injury（P 〈0.01 ）.In multivariate analysis,mean ipsilateral lung dose was the only variate associated with radiation-induced lung injury（P 〈0.05）.Con-clusion Gross tumor volume,mean ipsilateral lung dose,ipsilateral lung V20 and total lung dose are the risk factors for radiation-induced lung injury after 3D conformal radiation therapy in NSCLC patients.