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目的回顾性分析Ⅲ期非小细胞肺癌(NSCLC)三维适形放疗(3D-CRT)引起放射性肺炎(RP)发生的相关物理参数及临床影响因素。方法 2001年1月至2008年12月接受根治性3D-CRT的203例NSCLC临床资料,其中男163例、女40例;中位年龄63岁(30~83岁);21例有慢性阻塞性肺疾病(COPD)病史;ⅢA期79例、ⅢB期124例。70例单纯放疗、133例放化联合治疗,中位等效照射剂量6 200 c Gy(5 000~7 800 c Gy);RP评价采用RTOG标准,剂量体积直方图(DVH)评价物理参数与≥2级和≥3级RP的关系。统计分析采用SPSS13.0统计软件。结果 203例放疗后发生≥2级RP者32%(65/203),≥3级RP者20.7%(42/203)。Spearman相关和Logistic单因素分析显示,物理参数中肺平均剂量、双肺V5~V40,临床因素中COPD病史、分割方式(常规分割/大分割)、放疗剂量、GTV和GTV/肺体积均与≥2级和≥3级RP相关(P<0.05);而性别、年龄、吸烟、病变部位(中央型/周围型、肺上叶/肺中下叶)、化疗与否等均与≥2级和≥3级RP无明显关系(P>0.05)。Logistic多因素回归分析显示,肺V25是≥2级和≥3级RP的独立危险因素,ROC曲线显示肺V25分界值为29%;COPD是≥2级RP的独立危险因素。结论 DVH参数可用于预测和评价放射性肺炎,肺V25可能是最有效预测≥2级RP和≥3级RP的指标,合并COPD增加≥2级RP的发生率。
Objective To retrospectively analyze the relevant physical parameters and clinical influencing factors of radiation-induced pneumonia (RP) in non-small cell lung cancer (NSCLC) with three-dimensional conformal radiotherapy (3D-CRT). Methods The clinical data of 203 NSCLC patients who underwent radical 3D-CRT from January 2001 to December 2008 included 163 males and 40 females; the median age was 63 years (range, 30-83 years); 21 patients were chronically obstructive. A history of lung disease (COPD); 79 patients in IIIA and 124 in IIIB. 70 cases of radiotherapy alone and 133 cases of radiochemotherapy combined therapy with a median equivalent radiation dose of 6 200 c Gy (5 000-7 800 c Gy); RP evaluation using RTOG standard, dose volume volume histogram (DVH) to evaluate physical parameters and ≥ The relationship between Level 2 and ≥3 RP. Statistical analysis using SPSS13.0 statistical software. Results Among 203 patients with ≥2 grade RP, 32% (65/203) occurred after radiotherapy, and 20.7% (42/203) of grade 3 RP patients. Spearman correlation and Logistic univariate analysis showed that the average lung dose in physical parameters, V5~V40 in both lungs, history of COPD in clinical factors, segmentation method (conventional segmentation/large segmentation), radiotherapy dose, GTV and GTV/lung volume were all ≥ Grade 2 and grade ≥3 were associated with RP (P<0.05); sex, age, smoking, lesions (central/peripheral, upper lobe/lower lung lobe), and chemotherapy were all ≥2 grades. There was no significant relationship between ≥3 grade RP (P>0.05). Logistic multivariate regression analysis showed that lung V25 was an independent risk factor for ≥2 and ≥3 RP, ROC curve showed a lung V25 cutoff of 29%; COPD was an independent risk factor for ≥2 RP. Conclusions DVH parameters can be used to predict and evaluate radiation pneumonitis. Lung V25 may be the most effective predictor of ≥2 grade RP and ≥3 grade RP, and the incidence of ≥2 grade RP increases with COPD.