非小细胞肺癌患者调强适形放疗后重度急性放射性肺损伤的影响因素分析

Analysis of Influencing Factors of Severe Acute Radiation Lung Injury in Patients with Non-small Cell Lung Cancer After Intensity-modulated Conformal Radiotherapy

目的分析调强适形放疗(IMRT)非小细胞肺癌(NSCLC)患者发生重度急性放射性肺损伤的相关因素。方法回顾性分析2016年7月~2019年6月于本院接受IMRT后发生急性放射性肺损伤(ARP)的84例NSCLC患者的临床资料,根据疾病严重程度将重度ARP患者(21例)设为重度组,其余ARP患者(63例)设为普通组,比较两组性别、年龄、病理分型、双肺V5、双肺V20、双肺V30、合并慢阻肺、病变位置、临床分型、肿瘤分期的分布状况,分析导致NSCLC患者IMRT后发生重度ARP的危险因素。结果两组性别、病理分型、双肺V5、病变位置、临床分型、肿瘤分期的分布状况比较,差异无统计学意义(P>0.05);重度组年龄≥60岁、双肺V20≥30%、双肺V30≥20%、合并慢阻肺占比高于普通组,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,年龄≥60岁、双肺V20≥30%、双肺V30≥20%、合并慢阻肺是导致NSCLC患者IMRT后发生重度ARP的危险因素。结论年龄、双肺V20、双肺V30、合并慢阻肺与NSCLC患者IMRT后发生重度ARP密切相关,临床治疗中应尽量减小放疗的靶区体积,并对高龄、合并慢阻肺的患者进行合理干预,以降低重度ARP的发生率。

Objective To analyze the related factors of severe acute radiation lung injury in patients with intensity-modulated conformal radiotherapy(IMRT)non-small cell lung cancer(NSCLC).Methods A retrospective analysis of the clinical data of 84 patients with NSCLC who had acute radiation lung injury(ARP)after IMRT in our hospital from July 2016 to June 2019.According to the severity of the disease,the patients with severe ARP(21 cases)were set as In the severe group,the remaining ARP patients(63 cases)were set as the ordinary group.The two groups were compared with gender,age,pathological type,lung V5,lung V20,lung V30,combined with COPD,lesion location,clinical type,the distribution of tumor stages,analyze the risk factors that lead to severe ARP in NSCLC patients after IMRT.Results There was no statistically significant difference in the distribution of gender,pathological type,lung V5,lesion location,clinical type,and tumor stage between the two groups(P>0.05);severe group age≥60 years old,double lung V20≥30%,both lungs V30≥20%,and the proportion of COPD combined is higher than that of the ordinary group,the difference was statistically significant(P<0.05);Multivariate Logistic regression analysis shows that age≥60 years,both lungs V20≥30%,both lungs V30≥20%and COPD are the risk factors for severe ARP after IMRT in NSCLC patients.Conclusion Age,V20 in both lungs,V30 in both lungs,and COPD are closely related to the occurrence of severe ARP after IMRT in NSCLC patients.In clinical treatment,the volume of the radiotherapy target should be minimized,and the elderly patients with COPD should be treated Reasonable intervention to reduce the incidence of severe ARP.