锥形束CT图像引导技术对降低肺癌放疗患者放射性肺损伤发生风险的影响

Influence of cone-beam CT image guidance technology on reducing the risk of radiation-induced lung injury in patients treated with radiotherapy

目的探讨应用锥形束CT(CBCT)图像引导放射治疗(IGRT)技术对于肺癌放疗患者发生放射性肺损伤风险的影响。方法回顾性分析2013-01-01-2014-06-30于唐山市人民医院住院的164例肺癌放疗患者病历资料,根据放疗是否采用了CBCT IGRT技术分为CBCT组(51例)和非CBCT组(113例)。以发生2级以上放射性肺损伤为研究终点,以是否行CBCT图像引导放疗和其他临床特征作为预测因素,应用Logistics回归模型进行单因素和多因素分析,探讨放射性肺损伤相关因素。结果CBCT组和非CBCT组组间性别、年龄、病理类型等临床特征均衡,P>0.05。单因素分析发现,应用CBCT(OR=0.263,95%CI为0.1030.672,P<0.001)可降低放射性肺损伤的发生风险,同时放射物理剂量学参数放疗剂量≥60 Gy(OR=2.393,95%CI为1.1305.065,χ^(2)=5.356,P=0.021)、MLD(OR=6.206,95%CI为2.85913.475,χ^(2)=23.855,P<0.001)、V5≥75%(OR=5.690,95%CI为2.31613.976,χ^(2)=18.532,P<0.001)、V20≥35%(OR=4.040,95%CI为1.8678.743,χ^(2)=13.527,P<0.001)以及同期化疗(OR=2.660,95%CI为1.3075.413,χ^(2)=7.520,P=0.006)可增加放射性肺损伤的风险。排除共线性指标后,多因素分析提示CBCT(OR=0.316,95%CI为0.1180.851,χ^(2)=5.201,P=0.023)、MLD(OR=5.742,95%CI为2.54112.975,χ^(2)=17.654,P<0.001)和同期化疗(OR=2.292,95%CI为1.0415.044,χ^(2)=4.246,P=0.039)是放射性肺损伤发生的独立预测因素。结论应用CBCT IGRT可以降低肺癌放疗患者放射性肺损伤的发生风险。

Objective To explore the impact of cone-beam CT(CBCT)image guidance technology on the risk of radiation-induced lung injury in patients with lung cancer radiotherapy.Methods From January 1,2013 to June 30,2014,a total of 164 lung cancer patients treated with radiotherapy in Tangshan People’s Hospital were enrolled in the study.Radiation-induced lung injury with grade 2 or higher was used as the end point.Whether using CBCT image guided radiotherapy and other clinical features were used as predictors.Logistic regression model was used to perform univariate and multivariate analyses to find the independent predictive factors associated with radiation-induced lung injury.Results Among 164 lung cancer patients treated with radiotherapyand enrolled in this study,there was no significant difference in clinical features between the CBCT group and the non-CBCT group(P>0.05).Univariate analysis found that the application of CBCT(OR=0.263,95%CI=0.103-0.672,P<0.001)reduced the risk of radiation-induced lung injury,and radiation dosimetry parameters:Radiotherapy dose≥60 Gy(OR=2.393,95%CI:1.130-5.065,χ^(2)=5.356,P=0.021),MLD(OR=6.206,95%CI:2.859-13.475,χ^(2)=23.855,P<0.001),V5≥75%(OR=5.690,95%CI:2.316-13.976,χ^(2)=18.532,P<0.001),V20≥35%(OR=4.040,95%CI:1.867-8.743,χ^(2)=13.527,P<0.001)and concurrent radiotherapy and chemotherapy(OR=2.660,95%CI:1.307-5.413,χ^(2)=7.520,P=0.006)increased the risk of radiation-induced lung injury.After excluding the factors with collinearity,multivariate analysis indicated CBCT(OR=0.316,95%CI:0.118-0.851,χ^(2)=5.201,P=0.023)、MLD(OR=5.742,95%CI:2.541-12.975,χ^(2)=17.654,P<0.001)and concurrent chemotherapy(OR=2.292,95%CI:1.041-5.044,χ^(2)=4.246,P=0.039)were independent predictors of radiation-induced lung injury.Conclusion The application of CBCT image guidance technology can reduce the risk of radiation-induced lung injury in lung cancer patients treated with radiotherapy.