非小细胞肺癌三维适形放疗放射性肺损伤临床及剂量学因素分析

被引：34

作者：

王静

王平

庞青松

王伟

王军

袁智勇

机构：

[1] 天津医科大学附属肿瘤医院放疗科天津市肺癌诊治中心天津市“肿瘤防治”重点实验室

来源：

中华放射肿瘤学杂志 | 2009年 / 06期

基金：

天津市自然科学基金;

关键词：

肺肿瘤/放射疗法; 放射疗法,三维适形; 放射性肺损伤; 因素分析;

D O I：

暂无

中图分类号：

R686 [筋腱、韧带、滑囊疾病及损伤];

学科分类号：

100220 [骨科学];

摘要：

目的探讨非小细胞肺癌（NSCLC）根治性三维适形放疗（3DCRT）后放射性肺损伤发生因素。方法搜集86例接受根治性3DCRT[处方剂量≥60～66 Gy,1.8～2.0 Gy/（次·d）,5 d/周]的NSCLC患者资料,对性别、年龄、吸烟史、心脏病史、肺功能、发病部位、临床分期、病理诊断、是否合并化疗等临床因素以及放疗剂量、射野数量、平均肺受量（MLD）、正常肺体积剂量(V5～V65间隔5 Gy)等剂量学因素与放射性肺损伤之间的关系进行回顾性分析。采用CTC 3.0标准对放射性肺损伤进行分级,单因素及多因素分析筛选预测因素。结果中位随访期12个月（1～36个月）,12例发生≥3级放射性肺损伤。单因素分析V5～V35、MLD等因素与放射性肺损伤有关,而与全部临床因素、放疗剂量、照射野数、V40～V65等无关。筛选单因素分析中有统计学意义的因素进行Logistic回归分析,结果仅V5是放射性肺损伤发生的独立预后因素（x2=5.15,P=0.023）。V5≤45%组放射性肺损伤发病率为2%,V5>45%组为26%（x2=10.24,P=0.001）。结论受照体积可能比受照剂量对放射性肺损伤发生的影响更大。众多剂量学因素与放射性肺损伤发生相关,其中V5是独立预后因素。

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