新疆少数民族地区IMRT治疗肺癌诱发的急性放射性肺损伤的危险因素研究

Research of Relativerisk Factors for the Acute Radiation-induced Lung Injury Based on IMRT Treatment for the Lung Cancer in Xinjiang Ethnic Minority District

目的探究新疆少数民族地区IMRT治疗肺癌诱导的急性放射性肺损伤(ARILI)的相关危险因素。方法回顾性选取2014年1月~2017年12月笔者医院247例行IMRT治疗的肺癌患者作为研究对象。采用Logistic回归分析探究患者临床资料及放疗剂量等参数对发生急性放射性肺损伤的影响。结果247例采用IMRT治疗的肺癌患者中有48例(19.43%)发生了急性放射性肺损伤。单因分析发现性别、放疗部位、病理类型、总放疗剂量与ARILI的发生无关;而年龄、肺功能FEV 1%、平均肺剂量MLD、剂量参数[V20(%)、V30(%)]与急性放射性肺损伤的发生密切相关,差异有统计学意义(P<0.05)。采用Logistics多元回归发现导致肺癌患者发生急性放射性肺损伤的多因素有FEV 1%<70%、V20(%)>28%、MLD>13Gy(P<0.05),是ARILI发生率的独立影响因素。结论IMRT治疗非小细胞肺癌中,针对老年、吸烟、肺功能较差的患者应制定个体化放疗方案和预防治疗措施,同时设定合适的放疗参数如V20、V30、MLD剂量等,尽可能减少急性放射性肺损伤的发生。

Objective To explore the risk factors of the severe acute radiation-induced lung injury(ARILI)by IMRT treatment for lung cancer in xinjiang ethnic minority district.Methods 247 patients with non-small cell lung cancer with IMRT treatment in our hospital were retrospectively selected as the research objects from January 2014 to December 2017.Logistic regression analysis was used to explore the influence of clinical data and radiotherapy dose on the occurrence of acute severe radiation lung injury.Results Among 247 patients with NSCLC treated with IMRT,Only 48 cases suffered from acute radioactive lung injury(ARILI)with a rate of 19.43%.Gender,radiotherapy site,pathological type and total radiotherapy dose were not related to the occurrence of ARILI.However,age,lung function FEV 1%,mean lung dose MLD,dose parameters[V20(%),V30(%)]were significantly related to the occurrence of ARILI,and the difference was statistically significant(P<0.05).Using Logistics multiple regression,it was found that FEV 1%<70%,V20(%)>28%,MLD>13Gy(P<0.05)were the multiple factors leading to grade 3 and above acute and severe radiological lung injury in patients with lung cancer,which were independent factors influencing the incidence of ARILI.Conclusion During the IMRT treatment for lung cancer,the formulate individualized radiotherapy scheme and preventive measures should be developed for the elderly smoking,poor pulmonary function of patients.In addition,the appropriate parameters such as V20,V30,MLD dose radiotherapy should be also set for decreasing ARILI.