论文部分内容阅读
目的评价肺癌胸部放疗前及照射40～50 Gy时血浆中TGF-β、IL-6及ACE含量变化、肺受照射剂量体积因素与放射性肺炎发生的关系。方法67例肺癌患者按治疗常规给予放疗或(和)化疗;男60例,女7例,中位年龄58岁(26～81岁)。放疗前、照射40～50 Gy时采血冻存,采用酶联免疫吸附法检测血液中TGF-β、IL-6及ACE含量。放射性肺炎根据CTC AE3.0标准评价,评价终点为≥2级放射性肺炎。结果存活患者中位随访时间22.6个月。2级以上的放射性肺炎发生率25.4%。自放疗开始至发生放射性肺炎的中位时间73天。放疗前、放疗40～50 Gy时血浆中TGF-β、IL-6含量以及其在放疗期间的变化与放射性肺炎无明显相关性。发生放射性肺炎组患者的疗前、疗中血浆ACE含量明显低于未发生肺炎者(P=0.033、0.004)。发生放射性肺炎组的全肺接受10 Gy照射体积(V10)为44%,高于未发生肺炎组的39%(P=0.029)。健肺MLD、V10、V15、V20分别高于未发生肺炎组(1931 cGy:990 cGy、52%:35%、48%:23%、37%:10%,P<0.05)。将生物因素ACE含量和DVH参数联合分析发现疗中血浆ACE含量和全肺V10组合是放射性肺炎最强的预测因素。疗中ACE含量ACE>506 ng/ml且全肺V10≤40%时,放射性肺炎的发生风险最低,13例中无一发生;但如果ACE≤506 ng/ml且全肺V10>40%时,放射性肺炎风险达50%(6/12);其他情况疗中ACE>506 ng/ml且V10>40%或疗中ACE≤506 ng/ml且V10≤40%时,放射性肺炎发生率26.7%(P=0.008)。结论(1)放疗前、放疗中血浆ACE含量低是放射性肺炎发生的高危因素。(2)血浆ACE联合DVH参数V10有望作为预测放射性肺炎发生的指标。
Objective To evaluate the changes of plasma levels of TGF-β, IL-6 and ACE in lung cancer before radiotherapy and at 40-50 Gy, and the relationship between lung volume and radiation dose and the incidence of radiation pneumonitis. Methods Sixty-seven patients with lung cancer were treated by conventional radiotherapy or chemotherapy. There were 60 males and 7 females, with a median age of 58 years (ranged from 26 to 81 years). Blood samples were stored frozen before radiotherapy at 40-50 Gy, and the levels of TGF-β, IL-6 and ACE in the blood were detected by enzyme-linked immunosorbent assay. Radiation pneumonitis according to CTC AE3.0 standard evaluation, the end point of evaluation for ≥2 level of radiation pneumonitis. Results The median follow-up of survivors was 22.6 months. The incidence of radiation pneumonitis above Grade 2 is 25.4%. The median time from radiotherapy to the onset of radiation pneumonitis was 73 days. The levels of TGF-β and IL-6 in the plasma before and after radiotherapy 40 ~ 50 Gy and their changes during radiotherapy had no significant correlation with radiation pneumonitis. In patients with radiation pneumonitis, the plasma ACE levels in patients before and after treatment were significantly lower than those without pneumonia (P = 0.033,0.004). The incidence of radiation-exposed (10 Gy) radiation in the whole lung in the group receiving radiation pneumonitis was 44% higher than that in the group without pneumonia (P = 0.029). The levels of MLD, V10, V15 and V20 in lung were higher than those without pneumonia (1931 cGy: 990 cGy, 52%: 35%, 48%: 23%, 37%: 10%, P <0.05). The combination of biological factors and DVH parameters ACE content analysis found that plasma ACE concentration and pulmonary V10 combination is the strongest predictor of radiation pneumonitis. Radiation pneumonitis has the lowest risk of ACE pneumonitis with ACE levels of> 506 ng / ml and V10 ≤ 40% of the lungs, none of 13; however, if ACE ≤ 506 ng / ml and V10> 40% The incidence of radiation pneumonitis was 50% (6/12); for other conditions, the rate of radiation pneumonitis was 26.7% (P <0.05) when ACE was> 506 ng / ml and V10> 40% P = 0.008). Conclusions (1) The low plasma ACE level during radiotherapy before radiotherapy is the risk factor of radiation pneumonitis. (2) Plasma ACE combined with DVH parameter V10 is expected as an indicator of the occurrence of radiation pneumonitis.