The follow-up of 34 children with medulloblastoma who received 3-dimensional conformal radiation therapy

Objective:In our investigation,we studied the patients with medulloblastoma who received 3-dimensional conformal radiation therapy(3DCRT) and recorded their effects,side effects and failure reasons.Methods:From August 2001 to August 2007,34 children with medulloblastoma were treated in our hospital.The age at diagnosis was 3-16 years old,and the mean age at diagnosis was 9.5 years old.Among all the patients,16 cases were included in the high risk group and 18 cases were included in the low risk group.All the patients were performed total resection or subtotal resection and no patients received radiotherapy or chemotherapy before operation.All patients received 3DCRT within 3 weeks after resection.The dose of 30 Gy were given to the whole brain and whole spine,followed by 20-25 Gy boosted to the posterior brain fossa.The median fraction dose was 180 cGy.Every patient received the chemotherapy scheme of the Lomustine,Cisplatinum and Vincristine.Nobody received intrathecal chemotherapy.The tests of the complete blood count,blood biochemistry,hepatic and renal functions were required before every cycle of chemotherapy.Results:5-year overall survival(OS) and 5-year disease free survival(DFS) were 71% and 62% respectively.The median follow-up time was 36.5 months.The 5-year OS of the high risk group was 71% compared to 62% of the low risk group.There were significant difference between the two groups(P = 0.01).There were 13 failure cases in all the patients.Of these 13 patients,10 were dead and the other 3 were alive with tumor.The complete remission(CR) rate was 70.5% and the partial remission(PR) rate was 14%.Among the failure patients,there were 3 patients(8.8%) with the recurrences located in the brain of cribriform region.The 5-year OS of the patients with preoperative metastases was 12.5%(1/8),and which of the patients with residual tumor volume > 1.5 cm3 was 0%(0/5).Through the statistic analysis,it was found that both whether or not the metastases were found before surgery and residual tumor volume have the significant impacts on the prognosis of the children with medulloblastoma(P < 0.05).The major adverse reactions were hematological toxicity(7/34,20.6%) and gastrointestinal reaction(4/34,11.8%).Conclusion:Through the using of 3DCRT for the children with medulloblastoma,the severe side effects rate was not high.The prognosis of the patients in low risk group was satisfied which was opposite to that of the patients in high risk group.And the patients with residual tumor volume > 1.5 cm3 and preoperative metastases also had poor prognosis.It is needed to pay attention to the possible low dose of the brain of cribriform region.

Preliminary analysis of a clinical trial for three-dimensional conformal radiation therapy after conservative surgery

Objective The aim of this study was to evaluate the efficacy, complications and cosmetic results of three-dimensional conformal radiation therapy for early breast cancer after conservative surgery.

Influences of Motion Artifacts on Three-Dimensional Reconstruction Volume and Conformal Radiotherapy Planning

Objective ：To investigate the influences of motion artifacts on three-dimensional （3D） reconstruction volume and conformal radiotherapy planning. Methods： A phantom which can mimic the clip motion of lung tumor along the cranial-caudal direction is constructed by step motor, small ball of polyethylene and potato. Ten different scan protocols were set and CT data of the phantom were acquired by using a commercial GE LightSpeedl6 CT scanner. The 3D reconstruction of the CT data was implemented by adopting volume-rendering technology of GE AdvantageSim 6.0 system. The reconstructed volumes of each target in different scan protocols were measured through 3D measuring tools. Thus, relative deviations of the reconstruction volumes between moving targets and static ones were determined. The three-dimensional conformal radiation therapy （3D- CRT） plans and conformal fields were created and compared for a static/moving target with the WiMRT treatment planning system （TPS）. Results：For a static target, there was no obvious difference among the 3D reconstruction volumes when the CT data were acquired with different pitches and slices. The appearance of 3D reconstruction volume and 3D conformal field of a moving target was quite different from that of static one. The maximum relative deviation is nearly 90% for a moving target scanned with different scan protocols. The relative deviations are variable among the different targets, about from -39.8% to 89.5% for a smaller target and from - 18.4% to 20.5% for a larger one. Conclusion ：The motion artifacts have great effects on 3 D-CRT planning and reconstruction volume, which will greatly induce distorted conformal radiation fields and false DVHs for a moving target.

A dosimetric comparative study between conformal and intensity modulated radiation therapy in the treatment of primary nasopharyngeal carcinomas: the Egyptian experience

Objective: The study is a comparative study, the aim of which is to compare 3D conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) in treating nasopharyngeal carcinomas; dosimetrically evaluating and comparing both techniques as regard target coverage and doses to organs at risk (OAR). Methods: Twenty patients with nasopharyngeal carcinoma were treated by 3D-CRT technique and another 20 patients were treated by IMRT. A dosimetric comparison was done by performing two plans for the same patient using Eclipse planning system (version 8.6). Results: IMRT had a better tumor coverage and conformity index compared to 3D-CRT plans (P value of 0.001 and 0.004), respectively. As for the dose homogeneity it was also better in the IMRT plans and the reason for this was attributed to the dose inhomogeneity at the photon/electron junction in the 3D-CRT plans (P value 0.032). Also, doses received by the risk structures, particularly parotids, was significantly less in the IMRT plans than those of 3D-CRT (P value 0.001). Conclusion: IMRT technique was clearly able to increase the dose delivery to the target volume, improve conformity and homogeneity index and spare the parotid glands in comparison to 3D-CRT technique.

Role of radiation therapy in gastric adenocarcinoma

Outcomes in patients with gastric cancer in the United States remain disappointing, with a five-year overall survival rate of approximately 23%. Given high rates of local-regional control following surgery, a strong rationale exists for the use of adjuvant radiation therapy. Randomized trials have shown superior local control with adjuvant radiotherapy and improved overall survival with adjuvant chemoradiation. The benefit of adjuvant chemoradiation in patients who have undergone D2 lymph node dissection by an experienced surgeon is not known, and the benefit of adjuvant radiation therapy in addition to adjuvant chemotherapy continues to be defined. In unresectable disease, chemoradiation allows long-term survival in a small number of patients and provides effective palliation. Most trials show a benefit to combined modality therapy compared to chemotherapy or radiation therapy alone. The use of pre-operative, intra-operative, 3D conformal, and intensity modulated radiation therapy in gastric cancer is promising but requires further study. The current article reviews the role of radiation therapy in the treatment of resectable and unresectable gastric carcinoma, focusing on current recommendations in the United States.

The Effect of Absorbed Dose to Organs at Risk Following Craniospinal Irradiation Using Different Radiotherapy Techniques

Introduction: In medulloblastoma patients craniospinal irradiation is an important element the treatment. Our study aimed to evaluate the effect of absorbed dose to organs at risk using the hybrid intensity-modulated radiation therapy (IMRT) versus three-dimensional conformal radiotherapy (3DCRT) for craniospinal irradiation (CSI) in average risk medulloblastoma patients. Materials and Methods: In this study, thirteen medulloblastoma patients were included. The prescribed total dose to the planning target volume (PTV) was 23, 40 Gy in 13 fractions. Two radiotherapy techniques, three dimensional conformal radiotherapy (3DCRT) and hybrid intensity modulated radiotherapy (IMRT) were used to treat these patients. The coverage of the Target was evaluated using the D mean, D95%, D2%, D98% and V95%. Other parameters were also compared such as Integral dose (ID), Homogeneity index (HI) and doses to the organs at risk (OARs). Results: There was no significant difference in the mean dose received by the PTV-Brain or the dose received by 95% and 98% of PTV volume using the two techniques. For PTV-Spine, the percentage volume receiving 95% of the total dose increased significantly in the hybrid IMRT technique compared to the conformal technique. So, hybrid IMRT plan achieved the best coverage for PTV spine. Lower dose for OAR was delivered by 3DCRT, except the heart and thyroid, hybrid IMRT achieved better sparing. All plans resulted in the same dose homogeneity index (DHI) for PTV-Brain. For PTV-Spine, hybrid IMRT technique achieved better dose homogeneity compared to 3DCRT technique (1.09 vs. 1.12;p > 0.05). Conclusions: hybrid IMRT technique can be realized on conformal technique because it achieved better dose coverage for the (PTV) and organ at risk (OAR). 3DCRT reduced mean dose to most OARS, except the heart and thyroid. Therefore, the hybrid IMRT technique may be a CSI treatment alternative to 3DCRT.

3DCRT技术治疗原发性肝癌的临床剂量学研究

目的探讨3DCRT技术治疗原发性肝癌的方法、处方剂量与疗效的关系。方法27例有随访结果的肝癌患者,对其肿瘤体积大小、位置、处方剂量及生存期作回顾性总结。结果治疗后肿瘤局部控制率为85.2%(23/27),1年生存率为70.4%(19/27),2年生存率为55.6%(15/27),3年生存率为33.3%(9/27)。所有病人无放射性肝炎等严重副反应发生。结论3DCRT技术治疗不宜手术的肝癌是一种无创而有效的治疗方法,可提高肝癌的局部控制率,不良反应轻微,病人生存质量得到提高。

奥沙利铂联合3DCRT与单用3DCRT、奥沙利铂治疗晚期直肠癌近期疗效比较

目的比较奥沙利铂联合3DCRT与单用3DCRT、奥沙利铂应用于晚期直肠癌患者的近期疗效。方法选择72例晚期直肠癌患者,按随机数字表法分为观察组36例和对照组36例(对照组再均分为对照组A和对照组B,每组18例)。对照组A采用单纯3DCRT方法,对照组B采用单纯奥沙利铂治疗,观察组采用奥沙利铂联合3DCRT方法。对3组患者放疗后的近期疗效、1年生存率、2年生存率、及不良反应(骨髓抑制反应、胃肠道反应、神经毒性及放射性直肠炎)发生率进行比较。结果观察组总有效率为94.4%,对照组A总有效率为72.2%,对照组B总有效率为66.7%,观察组的总有效率明显优于对照组A和对照组B(均P<0.05);对照组A与对照组B总有效率比较,差异无统计学意义(P>0.05)。观察组的1年生存率(88.9%)和2年生存率(72.2%)均明显高于对照组A(66.7%、38.9%)和对照组B(61.1%、38.9%)(均P<0.05);对照组A与对照组B 2组患者的生存率相比较,差异无统计学意义(P>0.05)。观察组患者发生的不良反应中骨髓抑制反应、胃肠道反应及神经毒性,比对照组A明显(P<0.05),但在放射性直肠炎方面,2组比较差异无统计学意义(P>0.05);观察组患者发生的不良反应中骨髓抑制反应、胃肠道反应及神经毒性,与对照组B相比,差异无统计学意义(P>0.05),在放射性直肠炎方面,2组患者比较差异有统计学意义(P<0.05)。结论奥沙利铂联合3DCRT治疗晚期直肠癌患者可提高放疗疗效,在改善临床症状、提高生活质量等方面有较好的临床效果。

胰腺癌3DCRT计划设计中BAO和BAF两种优化的比较

目的：探讨胰腺癌射野角度优化（Beam Angle OptimizationBAO）方法对三维适形治疗（3DCRT）的计划质量及计划设计效率的影响。方法：对8例胰腺癌患者以相同的处方剂量，但分别采用BAO和固定射野角度（Beam Angle Fixed BAF）方法设计4野的三维适形治疗（3DCRT）计划，BAO计划组初始角度为0°、90°、180°、270°，最终射野角度由系统自动优化得到：BAF计划组射野角度基于物理师临床经验，采用试错方法（Trial-and-erro）得到。比较两组计划在剂量分布、靶区适形指数（CI）与均匀性指数（HI），不同危及器官（OAR）的照射剂量以及计划设计效率的差异性。结果：两组计划均能满足临床剂量要求，与BAF相比，BAO计划组靶区PTv适形指数CI较优（p=0．037），靶区PTV中位剂量Dso＊略高（p=0．011）；BAO计划组危及器官照射剂量均比BAF组低（P=O．叭2～0．525），其中肝脏和双肾的平均剂量D-有显著性差异（p=0．030，0．012）；BAO和BAF计划组总计划时间和总机器跳数（Mu）分别为5．0（±0．5）min、360（±32）MU和10（±1．0）min、365（±38）MU（P=0．000、0．981），BAO组在计划设计效率方面提高了100％。结论：相比于固定射野角度方法，使用射野角度优化（BAO）可得到更优的胰腺癌三维适形计划，且可提高计划设计的效率，可以在临床上开展广泛应用。

原发性肝癌TACE联合3DCRT与单纯TACE的疗效比较

目的比较经导管肝动脉化疗栓塞术(TACE)联合三维适形放疗(3DCRT)与单纯TACE对原发性肝癌(PHC)的疗效。方法80例PHC随机分为TACE联合3DCRT组和单纯TACE组。TACE联合3DCRT组40例接受TACE联合3DCRT治疗,而单纯TA-CE组仅接受TACE治疗。治疗结束后评价疗效。结果 TACE联合3DCRT组有效率为75.0%,单纯TACE组为45.0%,差异有统计学意义(P<0.05)。TACE联合3DCRT组0.5、1、2年生存率分别为72.5%、45.0%、27.5%,单纯TACE组分别为45.0%、25.0%、12.5%,差异均有统计学意义(P<0.05)。结论 TACE联合3DCRT治疗PHC的疗效优于单纯TACE。

替吉奥化疗联合3-DCRT对中晚期食管胃结合部肿瘤的疗效观察

目的探讨替吉奥化疗联合三维适形放疗对中晚期食管胃结合部肿瘤的临床疗效。方法中晚期食管胃结合部肿瘤患者98例,并随机分为2组,各49例。实验组患者采用替吉奥化疗联合三维适形放疗;对照组患者采用单纯性的三维适形放疗。比较2组患者治疗后总有效率及并发症情况。结果实验组治疗后总有效率(87.6%)显著高于对照组(67.3%),差异有统计学意义(P<0.05)。实验组毒副作用发生率显著低于对照组患者,差异有统计学意义(P<0.05)。结论替吉奥化疗联合三维适形放疗治疗中晚期食管胃结合部肿瘤具有良好的疗效,值得临床推广。

3DCRT治疗中不同部位恶性肿瘤外周血免疫细胞的动态变化

目的 探讨 3D立体定向适形放射治疗 (3D CRT)前后不同部位恶性肿瘤患者T ,B淋巴细胞和NK细胞的变化。方法 应用流式细胞技术对 4 3例恶性肿瘤患者在 3D CRT前和后 1,4周外周血CD3 ,CD4,CD8细胞 ,CD4/CD8比值 ,CD19细胞和NK细胞的变化。结果 (1)不同部位恶性肿瘤患者 3D CRT前CD3 ,CD4细胞 ,CD4/CD8比值 ,CD19及NK细胞均显著低于健康组 (P <0 .0 5 ,P <0 .0 1) ;(2 )照射后食管癌和直肠癌CD3 ,CD4细胞及CD4/CD8比值下降不明显 ,第4周时已回升 (P >0 .0 5 ) ;脑胶质瘤照射前后变化不显著 (P >0 .0 5 )。 (3)各类肿瘤照射期间CD19细胞、NK细胞无明显下降 (P >0 .0 5 )。结论 恶性肿瘤患者因 3D CRT治疗部位不同 ,其免疫功能细胞的改变有差异 ,临床可据此调整照射剂量、剂量分割及药物对抗。此外 ,CD19细胞和NK细胞对放疗的不敏感性是 3D

食管癌SIB-IMRT与3DCRT的剂量学疗效比较

目的比较食管癌同期加量调强放疗(SIB-IMRT)与三维适形放疗(3DCRT)的剂量学疗效。方法选择2 0 1 0年1月-2012年12月于我院接受3DCRT治疗的60例食管癌患者作为3DCRT组,按1:1比例选取2013年1月-2016年2月于我院接受SIBIMRT治疗的60例患者作为SIB-IMRT组,收集所有患者的临床资料,比较两组靶区剂量分布及靶区适形度指数(CI)、剂量均匀指数(HI)及危及器官组织受量,比较SIB-IMRT、3DCRT治疗的效果及安全性。结果 (1)SIB-IMRT组靶区Dmin、Dmean、V95、D95%及靶区肿瘤体积(GTV)Dmin、Dmean与计划靶体积(PTV)Dmax、Dmin、Dmean均高于3DCRT组(P﹤0.05);(2)SIBIMRT组CI高于3DCRT组,其HI低于3DCRT组(P﹤0.05);(3)SIB-IMRT组脊髓Dmax、肺V30低于3DCRT组,其肺V5高于3DCRT组(P﹤0.05);(4)SIB-IMRT组放射性食管炎发生率低于3DCRT组(P﹤0.05)。结论采用SIB-IMRT放疗计划治疗食管癌靶区剂量分布均匀性高,适形度好,危及器官受量低,安全性高。

局部晚期非小细胞肺癌3DCRT联合同步化疗的临床疗效观察

目的观察分析三维适形放射治疗（3DCRT）联合同步化疗治疗局部晚期非小细胞肺癌的临床效果。方法 68例局部晚期非小细胞肺癌患者,根据治疗方式不同分为同步化疗组和序贯化疗组,各34例。同步化疗组采用3DCRT联合同步化疗,序贯化疗组采用3DCRT治疗结束后再给予化疗。对比两组疗效。结果同步化疗组有效率为70.59%,序贯化疗组为64.71%,比较差异无统计学意义（P〉0.05）。同步化疗组2年生存率为38.2%（13/34）,序贯化疗组为26.5%（9/34）;同步化疗组中位生存期为17.0个月,序贯化疗组为13.0个月,采用log-rank检验,结果显示同步化疗组生存率优于序贯化疗组（χ-2=4.83,P〈0.05）。结论 3DCRT联合同步化疗治疗局部晚期非小细胞肺癌效果优于序贯化疗,两种治疗方法不良反应无差异,患者均可耐受。

Dosimetric evaluation of CR, 3DCRT and two types of IMRT for breast cancer after conservative surgery

Objective: The purpose of this study was to compare the dose distribution and dose volume histogram (DVH) of the planning target volume (PTV) and organs at risk (OARs) among conventional radiation therapy (CR), three-dimensional conformal radiation therapy (3DCRT), two-step intensity-modulated radiation therapy (TS-IMRT) and direct machine parameter optimization intensity-modulated radiation therapy (DMPO-IMRT) after breast-conserving surgery. Methods: For each of 20 randomly chosen patients, 4 plans were designed using 4 irradiation techniques. The prescribed dose was 50 Gy/2 Gy/25 f, 95% of the planning target volume received this dose. The cumulated DVHs and 3D dose distributions of CR, 3DCRT, TS-IMRT and DMPO-IMRT plans were compared. Results: For the homogeneity indices, no statistically significant difference was observed among CR, 3DCRT, TS-IMRT and DMPO-IMRT while the difference of the conformality indices were statistically significant. With regard to the organs at risk, IMRT and 3DCRT showed a significantly fewer exposure dose to the ipsilateral lung than CR in the high-dose area while in the low-dose area, IMRT demonstrated a significant increase of exposure dose to ipsilateral lung, heart and contralateral breast compared with 3DCRT and CR. In addition, the monitor units (MUs) for DMPO-IMRT were approximately 26% more than those of TS-IMRT and the segments of the former were approximately 24% less than those of the latter. Conclusion: Compared with CR, 3DCRT and IMRT improved the homogeneity and conformity of PTV, reduced the irradiated volume of OARs in high dose area but IMRT increased the irradiated volume of OARs in low dose area. DMPO-IMRT plan has fewer delivery time but more MUs than TS-IMRT.

食管癌3种放疗方式的疗效比较

目的探讨常规放疗、三维适形放疗(3DCRT)、调强放疗(IMRT)治疗食管癌的疗效差异。方法 117例食管癌中,38例采用常规放疗,32例采用3DCRT,47例采用IMRT。并对疗效和毒副反应进行比较分析。结果常规放疗组、3DCRT组和IMRT组的有效率分别为92.1%、96.9%、91.5%,差异无统计学意义(P=0.617)。3组1年生存率分别为77.9%、87.5%、86.7%(P=0.193);2年生存率分别为38.6%、55.1%、57.7%(P=0.211)。3DCRT组+IMRT组总疼痛缓解率为90.9%,常规放疗组为84.6%,差异无统计学意义(P=0.642)。放射性食管炎发生率3DCRT组+IMRT组较常规放疗组高(P=0.012),放射性肺炎发生率常规放疗组较3DCRT组+IMRT组高(P<0.001),放射性气管炎常规放疗组较3DCRT组+IMRT组高(P=0.028),骨髓抑制常规放疗组较3DCRT组+IMRT组高(P=0.010)。结论 3DCRT和IMRT能提高食管癌的临床疗效,并减轻患者的放射性损伤。

3D-CRT和VMAT对头颈部肿瘤患者甲状腺功能的影响

目的:研究三维适形放疗(3D-CRT)和容积调强放疗(VMAT)对头颈部肿瘤患者甲状腺功能的影响。方法:将2011年1月至2014年6月在重庆三峡中心医院肿瘤分院行放射治疗的14头颈部肿瘤患者随机分为3D-CRT组和VMAT组,各70例,3D-CRT组行3D-CRT治疗,VMATVMAT治疗,所有患者均完成放射治疗,随访24个月。观察放疗后临床疗效,分别检测放疗前、放束时、放疗后3、6、12、18、24个月血清促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)和游离甲状素(FT4)水平,采用QLQ-H&N35量表评分评价患者放疗前、放疗1个月、放疗后及放疗后6个月质量,记录随访期间甲状腺功能减退发生情况。结果:两组放疗后总有效率差异无统计学意义(05);放疗后6、12、18、24个月甲状腺功能减退情况,VMAT组TSH均显著低于3D-CRT组(P<0.0)疗后12、18、24个月,VMAT组FT3、FT4均显著高于3D-CRT组(P<0.05);放疗后6个月,VMAT组-H&N35量表评分显著低于3D-CRT组(P<0.05);随访24个月内两组甲状腺功能减退发生率差异统计学意义(P>0.05)。结论:3D-CRT和VMAT均是治疗头颈部肿瘤的有效放疗方法,但VMAT护患者甲状腺功能及改善治疗后生活质量方面优于3D-CRT。

上段食管癌累及野照射CRT、3D-CRT与IMRT计划的剂量学对比研究

目的比较颈段、胸上段食管癌常规放疗(CRT)、三维适形放疗(3D-CRT)、调强放疗(IMRT)累及野放疗中靶区和危及器官(OAR)的剂量学差异,进而为临床治疗选择最优放射治疗方案;比较不同大小肿瘤(直径<3 cm及>5 cm)不同放疗计划对危及器官的影响,进而选择较优的放疗计划。方法选择12例颈段及胸上段食管癌患者,应用三维治疗计划系统(TPS)分别为每位患者设计三种治疗计划(A.常规放疗;B三维适形放疗;C调强适形放疗),在规定CTV至少达到95%处方剂量前提下根据剂量体积直方图(DVH)、等剂量曲线比较三种计划靶区剂量分布及脊髓、气管、肺正常组织受量的差异;同时比较不同大小的肿瘤三种放疗计划对脊髓的剂量学影响。结果三种计划的靶区的平均剂量以IMRT计划为好,IMRT同时减少了脊髓及气管的剂量,差异有统计学意义(P<0.05);不管肿瘤直径大小,以IMRT计划最好。结论颈段及胸上段食管癌采用调强适形放疗,能在提高靶区剂量的同时更好的保护周围正常组织及器官,较三维适形放疗有剂量学优势,是目前较好的一种放疗方法。

3D-CRT与静态IMRT在局部晚期非小细胞肺癌治疗中的效果及安全性分析

目的:探讨三维适形放疗(3-dimensional conformal radiation therapy,3D-CRT)与静态调强放疗(intensity modulated radiation therapy,IMRT)在局部晚期非小细胞肺癌(locally advanced non-small cell lung cancer,LANSCLC)治疗中的效果及安全性。方法:选取2017年1月-2019年6月就诊于本院的82例LANSCLC患者,按随机数字表法将其分为A、B组,各41例。A组行静态IMRT,B组行3D-CRT。比较两组治疗效果、计划靶区剂量及治疗安全性。结果:两组治疗总有效率与平均剂量比较,差异均无统计学意义(P>0.05)。A组不均匀性指数(HI)高于B组,而适形指数(CI)水平低于对照组(P<0.05)。A组>Ⅲ度放射性食管炎、血小板减少、>Ⅲ度白细胞减少、>Ⅲ度放射性肺炎及>Ⅲ度消化道反应发生率均低于B组(P<0.05)。结论:3D-CRT与静态IMRT在LANSCLC治疗中的效果相似,但静态IMRT靶区剂量分布更优,能减少放疗毒副反应发生,而其低剂量区照射体积增大,需加以注意。

血清NOD样受体热蛋白结构域相关蛋白3炎症小体及呼出气一氧化氮评估三维适形放射治疗致放射性肺炎价值研究

目的探讨血清NOD样受体热蛋白结构域相关蛋白3(NLRP3)炎症小体表达水平及呼出气一氧化氮(FeNO)在评估三维适形放射治疗致放射性肺炎中的应用价值。方法选取自2018年12月至2021年1月江阴市人民医院收治的行三维适形放射治疗的胸部肿瘤患者103例,依照患者是否出现放射性肺炎分为非肺炎组(n=60)与肺炎组(n=43)。三维适形放射治疗结束后3 d,检测两组患者血清中NLRP3炎症小体水平;测定流速分别为50 ml/s、200 ml/s的FeNO水平。采用Logistics多元回归分析三维适形放射治疗致放射性肺炎的危险因素。绘制受试者工作特征(ROC)曲线,分析NLRP3炎症小体表达水平及FeNO预测三维适形放射治疗致放射性肺炎的应用价值。结果肺炎组患者血清NLRP3炎症小体及50 ml/s、200 ml/s时的FeNO水平均明显高于非肺炎组,差异有统计学意义(P<0.05)。Logistics多元回归分析发现,NLRP3炎症小体、FeNO_(50 ml/s)、FeNO_(200 ml)/s是三维适形放射治疗导致放射性肺炎的危险因素(P<0.05)。NLRP3炎症小体、FeNO_(50 ml/s)、FeNO_(200 ml)/s水平联合应用预测放射性肺炎的灵敏度、特异度及ROC曲线下面积均明显高于各指标单独应用,差异有统计学意义(P<0.05)。结论NLRP3炎症小体、FeNO水平联合应用预测放射性肺炎的灵敏度、特异度较高,优于单一指标预测。