三维适形放疗肺癌患者放射性肺炎相关因素分析.docVIP

三维适形放疗肺癌患者放射性肺炎相关因素分析 　【摘要】 目的探讨放射性肺炎的相关性因素，为临床治疗计划的制定提供参考标准。方法78例未经手术治疗的肺癌患者在放疗开始前1周进行肺功能检测，应用χ2和Logistic多元回归分析方法研究肺癌患者临床资料、剂量体积参数及肺功能指标与放射性肺炎的关系。临床资料：性别、年龄、临床分期、病理类型、是否化疗、是否合并慢性阻塞性肺病、是否合并肺不张和阻塞性肺炎、放疗方式及肿瘤位置；剂量体积参数包括双肺 V10、V15、V20、V25、V30、V35、V40，肺Dmean、Veff、 GTV大小、射野数。肺功能指标分析Fvc、Fev1.0、DLco。结果① 放射性肺损伤2级以上有18例(23.08%)；②单因素分析有统计学差异的相关因素是放疗前合并有慢性阻塞性肺病，GTV大小、Ｖ30，DLco (Plt;0.05)；③ 经过Binary Logistic回归模型分析，放疗前合并有慢性阻塞性肺病和V30gt;18%为放射性肺损伤发生的独立因素（P=0.018和0.037）。结论放射性肺损伤是个多因素综合影响的结果，对肺部有慢性疾病患者和基础肺功能异常（弥散功能为主）的患者应优选治疗方案，且肺V30控制在18%以下。 【关键词】 放射疗法；肺癌；肺功能；剂量体积直方图 　　Abstract：ObjectiveTo identify the risk factors of radiation pneumonitis，and provide the reference standard for the clinical best treatment plan.MethodsPulmonary function tests（PFTs） was measured in 78 patients with inoperable lung cancer at pretreatment 1 week.The prognostic clinical、dosevolume metrics and parameters PFTs of 78 patients were analysised using ChiSquare test and Logistic regression model. Prognostic clinical factors evaluated included：gender、age、clinical stage、pathology、 chemotherapy 、chronic obstructive pulmonary disease、 atelectasis、 RT model、 tumor position；dosevolume metrics：V10、V15、V20、V25、V30、V35、V40、lung Dmean、 effective volume(Veff) 、 gross target volume、number of exposed fields； parameters PFTs ：forced vital capacity(Fvc) 、forced expiratory volume in 1s (Fev1.0)、diffusion capacity of carbon monoxide(DLco).Results（1）18 patients were scored as having RTinduced pulmonary(≥2 grade) among 78. （2）The univariate analysis revealed that many parameters （COPD、tumor volume、V30、DLCO）were significantly associated with radiationinduced acute pulmonary toxicity (Plt;0.05). （3）Binary logistic analysis revealed that COPD and V30gt;18% were associated with radiationinduced acute pulmonary toxicity (P=0.018 and 0.037). ConclusionThe radiationinduced acute pulmonary toxicity is result of many factors. To patients with COPD or poor basic pulmonary function, V30 should be controlled below 18% in treatment p