局部晚期非小细胞肺癌患者放射性肺炎的临床及剂量学因素分析

Clinical and dosimetric factors of radiation pneumonitis in patients with locally advanced non-small cell lung cancer

目的探讨局部晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者接受胸部放疗后发生≥2级放射性肺炎(radiation pneumonitis,RP)的相关临床和剂量学因素。方法回顾性分析2016年1月—2018年1月四川大学华西医院接受胸部放疗的局部晚期NSCLC患者的临床因素和剂量学参数,对与发生≥2级RP相关的潜在因素进行logistic回归分析。结果共纳入104例患者,≥2级RP的发生率为19.2%。多因素logistic回归分析显示,心脏接受20 Gy以上剂量照射体积百分比(V_(20))[比值比(odds ratio,OR)=1.068,95%置信区间(confidence interval,CI)(1.004,1.137),P=0.036]、肺平均照射剂量(mean dose,D_(mean))[OR=1.003,95%CI(1.000,1.006),P=0.031]和上腔静脉D_(mean)[OR=1.001,95%CI(1.000,1.001),P=0.041]与≥2级RP相关。受试者操作特征曲线分析结果显示,联合心脏V20、肺D_(mean)和上腔静脉D_(mean)预测≥2级RP的曲线下面积为0.839[95%CI(0.752,0.926)]。此外,预测≥2级RP的心脏V_(20)、肺D_(mean)和上腔静脉D_(mean)的最佳临界值分别为20%、13 Gy和38 Gy。结论心脏V_(20)、肺D_(mean)和上腔静脉D_(mean)与局部晚期NSCLC患者接受胸部放疗后≥2级RP的发生相关。若将心脏V_(20)<20%、肺D_(mean)<13 Gy和上腔静脉D_(mean)<38 Gy作为正常器官剂量限量,或能降低局部晚期NSCLC患者胸部放疗后发生≥2级RP的风险。

Objective To investigate the clinical factors and dosimetric parameters associated with grade≥2 radiation pneumonitis(RP)after thoracic radiotherapy in patients with locally advanced non-small cell lung cancer(NSCLC).Methods The clinical factors and dosimetric parameters in patients with locally advanced NSCLC who received thoracic radiotherapy at West China Hospital of Sichuan University between January 2016 and January 2018 were retrospectively analyzed.The potential factors associated with the occurrence of grade≥2 RP were analyzed with logistic regression analysis.Results A total of 104 patients were included,and the incidence rate of grade≥2 RP was 19.2%.Multivariate logistic regression analysis showed that the percentage of the heart volume that received more than 20 Gy(V20)[odds ratio(OR)=1.068,95% confidence interval(CI)(1.004,1.137),P=0.036],lung mean dose(D_(mean))[OR=1.003,95%CI(1.000,1.006),P=0.031]and superior vena cava D_(mean)[OR=1.001,95%CI(1.000,1.001),P=0.041]were associated with grade≥2 RP.Receiver operating characteristic(ROC)curve analysis showed that the area under the ROC curve combined with heart V_(20),lung D_(mean) and superior vena cava D_(mean) to predict grade≥2 RP was 0.839[95%CI(0.752,0.926)].In addition,the optimal critical values for heart V_(20),lung D_(mean) and superior vena cava D_(mean) to predict grade≥2 RP were 20%,13 Gy and 38 Gy,respectively.Conclusions Heart V_(20),lung D_(mean) and superior vena cava D_(mean) are associated with grade≥2 RP after thoracic radiotherapy in patients with locally advanced NSCLC.In addition,taking heart V_(20)<20%,lung D_(mean)<13 Gy and superior vena cava D_(mean)<38 Gy as normal organ dose limits may reduce the risk of grade≥2 RP after thoracic radiotherapy for locally advanced NSCLC patients.