肺癌调强放疗引起放射性心脏损伤的相关因素

Related Factors for Radiation-Induced Heart Damage After Intensity Modulated Radiation Therapy in Patients with Lung Cancer

[目的]观察肺癌调强放射治疗（IMRT）所致放射性心脏损伤的相关影响因素。[方法]回顾性分析2015年10月至2017年3月期间接受IMRT的61例肺癌患者,采用RTOG标准评价患者急性放射性心脏损伤（RIHD）状况。剂量体积直方图（DVH）评估物理学参数。对与RIHD相关的临床因素及物理参数进行相关性分析及Mann-Whitney秩和检验。采用线性回归多重共线性诊断DVH物理参数之间的共线性并纠正。采用Logistic法进行多因素分析。[结果] 30例发生了1级急性放射性心脏损伤,发生率为49.2%。性别、肿瘤分类、临床N分期、高血压病史与RIHD具有相关性（r=-0.241~0.258,P〈0.05）。发生RIHD组与未发生RIHD组在心脏V5~V50、心脏平均剂量、心脏体积、PTV/心脏体积比、以及心脏各腔左心房Dmean、D50、V5~60;左心室Dmean、D50、V20;右心房Dmean、D50、V5、V20;右心室Dmean、D50、V5~50差异有统计学意义（P〈0.05）。Logistic多因素分析显示高血压史、心脏体积、PTV/心脏体积比、右心室DVH参数是RIHD的独立预后因素。[结论]较小心脏体积及较大PTV/心脏体积比的肺癌患者RIHD明显增加,特别既往存在高血压。右心室DVH参数,尤其是D50可评估预测RIHD的发生。

[Objective] To examine the risk factors of radiation-induced heart damage（RIHD） in the patient with lung cancer treated with intensity modulated radiation therapy（IMRT）. [Methods] From October 2015 to March 2017,61 patients with lung cancer underwent IMRT. The RIHD after treatment was assessed with RTOG standard. The dosimetric parameters was evaluated by dose volume histogram（DVH）. The related clinical and dosimetric parameters were analyzed by Spearman correlation and Mann-Whitney rank sum test. Linear regression was used for diagnosis and rectification of the multiple collinearity. Logistic regression was used for multivariate analysis. [Results] The overall incidence rate of RIHD was 49.2%（30 patients）,all of grade 1.0. Spearman correlation analysis showed that the factors correlated with RHID were gender,tumor classification,clinical N stage and history of hypertension（r=-0.241~0.258,P〈0.05）. Mann-Whitney rank sum test showed that there were significant differences in heart V5~V50,heart medium dose,heart volume,PTV/heart volume and Dmean,D50,V5~60 of left atrium,Dmean,D50,V20 of left ventricle,Dmean,D50,V5,V20 of right atrium and Dmean,D50,V5~50 of right ventricle between RHID and non-RHID groups（P〈0.05）. Multivariate analysis showed that history of hypertension,heart volume,PTV/heart volume and right ventricle DVH variable were independent risk factors for RHID. [Conclusion] Patients with smaller heart volume and larger PTV/heart volume would increase the risk of RHID,especially those with history of hypertension. Right ventricle DVH,especially D50 may be used for assessing and predicting RHID after IMRT in lung cancer patients.