31例累及纵隔淋巴瘤药物性肺损伤后放射性肺炎风险因素分析

Risk factors of radiation pneumonia for 31 mediastinal lymphoma cases with drug-induced lung injury

目的 分析累及纵隔淋巴瘤发生药物性肺损伤后发生放射性肺炎风险的临床因素及剂量学参数,并推导出剂量学参数相关阈值。方法 回顾性分析2010年12月至2019年12月湖南省肿瘤医院/湘雅医学院附属肿瘤医院收治的发生药物性肺损伤并接受放疗的累及纵隔淋巴瘤患者31例。采用Fisher精确检验、非参数检验和单因素分析比较有无发生放射性肺炎的患者的临床特征和放疗剂量学参数,采用受试者操作特征(receiver operating characteristic,ROC)曲线确定放射性肺炎风险预测因素的相关阈值。结果 31例患者中,放射性肺炎发生率为77.4%(24/31),无5级放射性肺炎发生。有无发生放射性肺炎患者在性别、年龄、淋巴瘤病理类型、疾病分期、吸烟史、纵隔大肿块、博莱霉素肺毒性、利妥昔单抗肺毒性、放疗前肺功能和自体造血干细胞移植这些临床特征方面比较,差异均无统计学意义(均P>0.05),而在剂量学因素V5、V10、V15、V20、V25和平均肺剂量(mean lung dose,MLD)方面比较,差异均具有统计学意义(均P<0.01)。ROC曲线分析显示,剂量学参数V5、V10、V15、V20、V25和MLD预测放射性肺炎发生的最佳临界值分别为47.355%、40.185%、22.22%、22.85%、15.53%和10.20 Gy。结论 对于累及纵隔淋巴瘤行化疗联合放疗的患者,发生药物性肺损伤后放射性肺炎发生比例提高,相关临床因素对于预测放射性肺炎的发生无意义。放疗剂量学参数包括肺V5、V10、V15、V20、V25和MLD均可以预测放射性肺炎的发生,相关参数阈值分别为47.355%、40.185%、22.22%、22.85%、15.53%和10.20Gy。

Objective To explore the clinical factors and dosimetric parameters related to the risk of radiation pneumonia after drug-in-duced lung injury in mediastinal lymphoma,and to deduce the threshold of dosimetric parameters related to the incidence of radiation pneumonia.Methods A retrospective analysis was performed on 31 mediastinal lymphoma cases with drug-induced lung injury and treated with radiotherapy in Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya School of Medicine,from December 2010 to December 2019.Fisher's exact test,nonparametric test and univariate analysis were used to compare the clinical characteristics and dosi-metric parameters of patients with and without radiation pneumonia after drug-induced lung injury.The receiver operating characteristic(ROC)curve was used to determine the correlation threshold of risk factors of radiation pneumonia.Results The incidence of all grades of radiation pneumonia was 77.4%(24/31),and no grade 5 radiation pneumonia occurred.There were no significant differences in sex,age,pathological type of lymphoma,disease stage,smoking history,mediastinal mass,pulmonary toxicity of bleomycin,pulmonary toxicity of rituximab,lung function before radiotherapy and autologous hematopoietic stem cell transplantation between patients with and without ra-diation pneumonia(all P>0.05),while significant differences in dosimetric parameters V5,V10,V15,V20,V25 and mean lung dose(MLD)were found(all P<0.01).ROC curve analysis showed that the threshold values of dosimetric parameters V5,V10,V15,V20,V25,and MLD for predicting the occurrence of radiation pneumonia were 47.355%,40.185%,22.22%,22.85%,15.53%,and 10.20 Gy,respectively.Conclusions For mediastinal lymphoma patients treated with chemotherapy combined with radiotherapy,the incidence of radiation pneu-monia increases significantly after drug-induced lung injury,and the related clinical factors have no significance in predicting the occur-rence of radiation pneumonia.Radiotherapy dosimetric parameters including V5,V10,V15,V20,V25 and MLD can predict the occurrence of radiation pneumonia,and the threshold values of these parameters are 47.355%,40.185%,22.22%,22.85%,15.53%and 10.20 Gy,respectively.