乳腺癌改良根治术后放疗所致的放射性肺炎危险因素分析

Analysis of Risk Factors of Radiation Pneumonia Caused by Radiotherapy after Modified Radical Mastectomy for Breast Cancer

目的:研究乳腺癌改良根治术(MRM)后放疗所致的放射性肺炎(RP)影响因素。方法:选取2017年2月-2020年2月佳木斯市妇幼保健院收治的241例乳腺癌患者。按照是否发生RP将患者分为肺炎组37例及无肺炎组204例,分析两组临床资料及放疗剂量学参数的差异。采用logistic回归分析MRM后放疗所致RP的影响因素。结果:肺炎组贫血及化疗人数占比均高于无肺炎组(P<0.05)。两组年龄、绝经、临床分期、放疗前内分泌治疗、放疗模式及放疗技术比较,差异均无统计学意义(P>0.05)。肺炎组计划靶体积1(PTV1)、计划靶体积2(PTV2)、接受5 Gy照射的肺体积占全肺体积的百分比(V5)、接受10 Gy照射的肺体积占全肺体积的百分比(V10)、接受20 Gy照射的肺体积占全肺体积的百分比(V20)及全肺平均耐受剂量(MLD)均高于无肺炎组(P<0.05)。logistic回归分析显示贫血及V5均是MRM后放疗发生RP的独立危险因素(P<0.05)。结论:MRM后放疗所致放射性肺炎影响因素包括贫血及V5。

Objective:To study and analyze the influencing factors of radiation pneumonia(RP)caused by modified radical mastectomy(MRM)radiotherapy for breast cancer.Method:A total of 241 breast cancer patients admitted to Jiamusi Maternal and Child Health Hospital from February 2017 to February 2020 were selected,according to RP or not,the patients were divided into pneumonia group(37 cases)and non-pneumonia group(204 cases).The differences of clinical data and radiotherapy dosimetry parameters between the two groups were analyzed.logistic regression was used to analyze the influencing factors of RP caused by radiotherapy after MRM.Result:The proportion of patients with anemia and chemotherapy in the pneumonia group were higher than those in the non-pneumonia group(P<0.05).There were no significant differences in age,menopause,clinical stage,pre-radiotherapy endocrine therapy,radiotherapy mode and radiotherapy technique between the two groups(P>0.05).In the pneumonia group,planned target volume 1(PTV1),planned target volume 2(PTV2),percentage of lung volume irradiated by 5 Gy in total lung volume(V5),percentage of lung volume irradiated by 10 Gy in total lung volume(V10),percentage of lung volume irradiated by 20 Gy in total lung volume(V20),and mean whole lung tolerated dose(MLD)were higher than those in non-pneumonia group(P<0.05).logistic regression analysis showed that anemia and V5 were independent risk factors for RP after MRM radiotherapy(P<0.05).Conclusion:The influencing factors of RP caused by MRM radiotherapy for breast cancer include anemia and V5.