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目的探讨非小细胞肺癌患者三维适形放疗中各种因素对放射性肺损伤的预测价值。方法非小细胞肺癌患者118例采用三维适形方案放疗,6 MV X线,每次1.8~2 Gy,每周5次,保持总剂量为50 Gy以上。收集118例患者的相关临床因素,观察肿瘤的生物学因素以及肿瘤治疗的方案(包括放疗及其他治疗方式)等对放疗性肺损伤的影响,并对此因素进行单因素和多因素分析。结果发生肺损伤103例,发生率87.3%。单因素分析显示,仅大体肿瘤体积和部分剂量体积参数如患者的平均肺剂量、患肺V20和全肺平均肺剂量对放射性肺损伤有影响(P<0.01),而其他因素影响不显著。多因素分析显示,剂量体积参数中仅平均肺剂量为放射性肺损伤独立相关因素(P<0.05)。结论大体肿瘤体积、平均肺剂量、患肺V20和全肺平均肺剂量是非小细胞肺癌患者三维适形放疗后发生放射性肺损伤的危险因素。
Objective To investigate the predictive value of various factors in radiation-induced lung injury in patients with non-small cell lung cancer in three-dimensional conformal radiotherapy. Methods 118 cases of non-small cell lung cancer patients were treated with 3-dimensional conformal radiotherapy, 6 MV X-ray, 1.8-2 Gy each time, 5 times a week for a total dose of 50 Gy. The clinical factors of 118 patients were collected. The biological factors of tumor and the effects of tumor therapy (including radiotherapy and other treatment methods) on the lung injury were observed. Univariate and multivariate analyzes were performed on the factors. Results of lung injury in 103 cases, the incidence rate of 87.3%. Univariate analysis showed that only gross tumor volume and partial dose volume parameters such as patient’s average lung dose, affected lung V20 and average lung dose all had effects on radiation-induced lung injury (P <0.01), while other factors had no significant effect. In the multivariate analysis, only the mean lung dose in the dose-volume parameters was independently correlated with radiation-induced lung injury (P <0.05). Conclusions General tumor volume, average lung dose, V20-affected lung and mean lung-lung dose are the risk factors for radiation-induced lung injury in patients with non-small cell lung cancer after three-dimensional conformal radiotherapy.