放射性肺损伤预测因素

Factors predicting radiation-induced lung injury

目的肺癌死亡率占全世界所有恶性肿瘤的第1位,大约2/3的肺癌患者需要放射治疗,然而肺癌患者的放疗剂量因放射性肺损伤(radiation-induced lung injury,RILI)而受限。本文回顾和总结国内外预测RILI的因素,为胸部放射治疗策略提供参考。方法应用Pubmed和万方数据库检索系统,以"RILI、剂量体积参数、生物因素"为关键词,检索2001-01-01-2015-12-31有关RILI的文献,共获得102篇英文文献和21篇中文文献。纳入标准:(1)RILI的影响因素;(2)RILI的预测因素。根据纳入标准纳入分析33篇文献。结果预测RILI的主要因素包括:(1)患者情况:年龄、吸烟状况和基础肺功能;(2)疾病本身;(3)剂量体积参数V5、V20、V30和MLD,化疗药物;(4)生物因素:细胞因子、抗氧化酶、免疫因子和单核苷酸多态性。结论在胸部放疗中RILI的发生是不可避免的,关于RILI的预测还需进一步研究,单核苷酸多态性和免疫机制是研究热点。

OBJECTIVE The mortality due to lung cancer is the first in cancer mortality all the world. About two- thirds of patients need to radiation therapy for lung cancer. However Radiation-induced lung injury is dose-limiting complication of thoracic radiation therapy. The text aimed to review the factors predicting radiation induced lung injury at home and abroad and to guide the thoracic radiotherapy. METHODS Using ＂radiation-induced lung injury, dose volume parameter. biological factors＂ as keywords,the 102 English and 21 Chinese literatures were separately searched in Pubmed and WANFANG data-bases between 2001-01-01 and 2015-12-31. Inclusion criteria： the infuence factors of radiation-induced lung injury;the predicting factors of radiation-induced lung injury. A total of 33 literatures were selected. RESULT The following are the factors predicting radiation-induced lung injury： patient related, including age, smoking and pulmonary function at baseline;disease related; treatment related,dose volume parameter, including V5, V20, V30, MLD and chemotherapeutics; biological factors, cytokines, immune factors, antioxidant enzymes and single nucleotide polymorphisms. CONCLUSIONS More effective researches are expected to predict the radiation induced lung injury. SNPs and Immune factors may be the future for individual prediction.