非小细胞肺癌患者放疗前后肺功能动态变化观察

A clinical observation of pulmonary function changes following radiation therapy in patients with non-small cell lung cancer

目的观察非小细胞肺癌(NSCLC)患者放疗前后肺功能的动态变化。方法选择82例NSCLC患者,均给予三维适形调强放疗。于放疗前及放疗后1、3个月测量第一秒用力呼气量(FEV1)、用力肺活量(FVC)及肺一氧化碳弥散量(DLCO);记录剂量-体积直方图(DVH)参数,包括靶体积20(V20)、靶体积30(V30)及全肺平均剂量(MLD);观察放射性肺炎的发生情况并比较其与肺功能(FEV1、FVC、DLCO)的关系,分析放射性肺炎分级与DVH参数的关系。结果 NSCLC患者放疗后1个月FEV1、FVC均高于放疗前,DLCO低于放疗前,差异均有统计学意义(P﹤0.05)。放疗后3个月NSCLC患者的FVC、FEV1与放疗前比较,差异均无统计学意义(P﹥0.05);而DLCO低于放疗前,差异有统计学意义(P﹤0.05)。82例NSCLC患者中发生放射性肺炎10例,其中1级4例、2级2例、3级4例。放疗后3个月,发生放射性肺炎与未发生放射性肺炎的患者FEV1、FVC比较,差异均无统计学意义(P﹥0.05);而DLCO均低于放疗前,且发生放射性肺炎的患者DLCO低于未发生放射性肺炎的患者,差异均有统计学意义(P﹤0.05)。放射性肺炎1级患者的V20、V30及MLD均低于2~3级患者,差异均有统计学意义(P﹤0.05)。结论放疗对NSCLC患者肺功能的影响是一个渐变的过程,通过观察肺功能的动态变化可以预测放射性肺炎的发生风险,建议NSCLC患者在放疗早期实施必要的临床干预。

Objective To observe the pulmonary function changes following radiation therapy in patients with nonsmall cell lung cancer（NSCLC）. Method Eighty-two patients with NSCLC who received three-dimensional conformal radiation therapy were enrolled. Then forced expiratory volume in first second（FEV1）, forced vital capacity（FVC） and diffusion capacity for carbon monoxide of lung（DLCO） were measured before radiotherapy and at 1 th and 3 rd month after the therapy; dose-volume histogram（DVH） parameters, including target volume 20（V20）, target volume 30（V30） and total mean lung dose（MLD）, were recorded; the occurrence of radiation pneumonia was observed and the relationship of radiation pneumonitis and lung function（FEV1, FVC and DLCO） and the relationship of radiation pneumonia grading and DVH parameters were analyzed. Result After radiotherapy for 1 month, FEV1 and FVC of the NSCLC patients were all higher than those of patients before radiotherapy, and the DLCO was lower than that of patients before radiotherapy, and the differences were statistically significant（P〈0.05）. Between 3 months after radiotherapy and before radiotherapy, there were no difference in FVC and FEV1 in patients with NSCLC（P〉0.05）. DLCO at 3 months after radiotherapy was lower than that before radiotherapy（P〈0.05）. There were 10 cases out of 82 patients with radiation pneumonia, including 4 cases of level 1, 2 cases of level 2 and 4 cases of level 3. At the 3 rd month after radiotherapy, there were no difference between patients with and without radiation pneumonia in FEV1 and FVC（P〉0.05）; while DLCO in patients with and without radiation pneumonia were all decreased, and the DLCO of patients with radiation pneumonia was lower than that of patients without radiation pneumonia（P〈0.05）. The V20, V30 and MLD of patients with level 1 radiation pneumonia were lower than those of patients with level 2-3 radiation pneumonia（P〈0.05）. Conclusion The effect of radiotherapy on pulmonary function in patients with NSCLC was gradual, by observing the dynamic pulmonary function changes can predict the occurrence of radioactive pneumonia. It＇s recommended that necessary clinical interventions be performed early in radiotherapy for NSCLC patients.