乳腺癌改良根治术后放疗诱发放射性肺炎的危险因素分析

Analysis of risk factors for radiation pneumonitis after modified radical mastectomy

目的探讨乳腺癌改良根治术后放疗诱发放射性肺炎(RP)的相关因素。方法选取2017年12月至2019年12月在温州市中心医院就诊的120乳腺癌患者作为研究对象,所有病例均行乳腺癌改良根治术并实施术后放射治疗。采用单因素及多因素Logistic回归分析年龄、绝经状态、肿瘤位置、临床分期、放疗前化疗、放疗总剂量、双肺V5、V20及平均耐受剂量(MLD)对放射性肺炎的影响。结果120例乳腺癌改良根治术后放疗后患者中23例出现急性或慢性放射性肺损伤,17例发生RP,RP发生率为14.17%。单因素分析显示血红蛋白正常的乳腺癌患者RP的发生率显著低于贫血患者(χ^(2)=8.038,P<0.05),放疗前接受过化疗的乳腺癌患者RP发生率显著高于未接受过化疗的患者(χ^(2)=6.397,P<0.05),而不同年龄、绝经状态、分期、放疗前内分泌治疗与否、放疗模式、放疗技术之间比较差异均无统计学意义(χ^(2)值为0.003~0.473,均P>0.05)。发生RP的乳腺癌患者的PTV1肿瘤体积、PTV2肿瘤体积、V5、V10、V20、全肺MLD的照射剂量显著高于未发生PR的患者,差异有统计学差异(t值分别为4.678、3.907、2.576、3.754、2.903、3.115,均P<0.05),而发生RP乳腺癌患者的V30、V40、V50与未发生RP乳腺癌患者之间比较,差异均无统计学意义(t值分别为0.325、0.216、0.307,均P>0.05)。Logistic多因素分析结果显示V5是乳腺癌改良根治术放疗后发生RP的独立预后因素(RR=1.343,P<0.05)。结论乳腺癌改良术后接受放射治疗的患者应该考虑双肺的放疗剂量,设定合理的放疗计划参数,可能可以降低放射性肺炎的发生率。

Objective To explore the risk factors of radiation pneumonitis(RP)induced by radiotherapy after modified radical mastectomy.Methods A total of 120 patients with breast cancer admitted to the Central Hospital of Wenzhou City from December 2017 to December 2019 were selected as the research subjects.All patients underwent modified radical mastectomy and radiotherapy after surgery.The univariate and multivariate Logistic regression analysis were used to analyze the effects of age,menopausal status,tumor location,clinical stage,pre-radiotherapy chemotherapy,total dose of radiotherapy,double lung V5,V20 and mean tolerated dose(MLD)on radiation pneumonitis.Results Among the 120 patients after radiotherapy and modified radical mastectomy,acute or chronic radiation lung injury occurred in 23 patients and RP occurred in 17 patients,with the incidence of RP was 14.17%.Univariate analysis showed that normal hemoglobin anemia patients have lower incidence of breast cancer patients with RP than patients with anemia(χ^(2)=8.038,P<0.05),the incidence of RP was significantly higher in breast cancer patients with chemotherapy than that in patients without chemotherapy(χ^(2)=6.397,P<0.05).No significant differences were found in age,menopausal status,clinical stage,endocrine therapy or not before radiotherapy,radiation patterns and radiotherapy technique between the two groups(χ^(2) values ranged from 0.003 to 0.473,all P>0.05).The PTV1 tumor volume,PTV2 tumor volume,V5,V10,V20,full dose of lung MLD in patients with RP were significantly higher than those of patients without RP(t values were 4.678,3.907,2.576,3.754,2.903 and 3.115,respectively,all P<0.05),while no significant differences were found in V30,V40 and V50 between breast cancer patients with RP and without RP(t values were 0.325,0.216 and 0.307,respectively,all P>0.05).Logistic multivariate analysis showed that V5 was an independent prognostic factor for RP after radiotherapy in modified radical mastectomy(RR=1.343,P<0.05).Conclusion Patients undergoing radiotherapy after modified breast cancer should consider the radiation dose of both lungs and set reasonable radiotherapy planning parameters,which may reduce the incidence of radiation pneumonitis.