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目的分析三维适形放疗(3DCRT)的ⅢA和ⅢB期非小细胞肺癌病例,分别评估≥2、3级放射性肺炎的发生与临床及剂量学参数的关系。方法107例病理组织学证实的ⅢA、ⅢB期非小细胞肺癌接受了平均60(26-74)Gy的3DCRT,其中42例单纯放疗,65例序贯放化疗。记录各临床因素及剂量体积直方图(DVH)参数,观察放疗结束3个月内发生的≥2级放射性肺炎(RP)和≥3级的放射性肺炎(SRP)。分级采用NCICTC3.0标准,统计用SPSS10.0软件包。结果107例共发生放射性肺炎39例,其中2级26例,3级10例,5级3例,SRP标准的13例。对RP单因素分析显示MLD、IMLD、CMLD、IV20-IV35、CV10、CV15、CV40、CV50及V10-V35有统计学意义(P=0.004、0.009、0.047、0.010、0.008、0.014、0.031、0.022、0.016、0.023、0.026、0.048、0.006、0.002、0.027、0.032、0.043),多因素分析显示V20是惟一RP发生的预测因子(P=0.005)。对SRP单因素分析显示MLD、IV20、IV25、IV30、CV5、CV10、V10、V15、V20、V30有统计学意义(P=0.005),多因素分析显示CV10是惟一SRP发生的预测因子(P=0.028)。结论对Ⅲ期非小细胞肺癌3DCRT,DVH参数与放射性肺炎的发生明显相关,其中V20、CV10分别是预测RP、SRP的剂量学指标。
Objective To analyze the cases of stage ⅢA and ⅢB non-small cell lung cancer (3DCRT) and evaluate the relationship between the incidence of ≥2 and 3 radiation pneumonitis and clinical and dosimetric parameters. Methods A total of 107 patients with pathologically confirmed stage Ⅲ A and Ⅲ B NSCLC received an average of 60 (26-74) Gy 3DCRT, of which 42 were treated with radiotherapy alone and 65 with sequential chemoradiotherapy. The clinical parameters and dose-volume histogram (DVH) parameters were recorded. Radiation pneumonitis (RP) ≥2 and radiation pneumonitis (SRP) ≥3 were observed within 3 months after the end of radiotherapy. Grading using NCICTC3.0 standard, statistical SPSS10.0 software package. Results A total of 107 cases of radiation pneumonitis occurred in 39 cases, of which 26 cases were grade 2, 10 cases were grade 3, 5 cases were grade 5 and 13 cases were SRP standard. Univariate analysis of RP showed that there was statistical significance in MLD, IMLD, CMLD, IV20-IV35, CV10, CV15, CV40, CV50 and V10- V35 (P = 0.004,0.009,0.047,0.010,0.008,0.014,0.031,0.022, 0.016,0.023,0.026,0.048,0.006,0.002,0.027,0.032,0.043), multivariate analysis showed that V20 was the only predictor of RP (P = 0.005). Univariate analysis of SRP showed statistical significance (P = 0.005) for MLD, IV20, IV25, IV30, CV5, CV10, V10, V15, V20 and V30 and multivariate analysis showed that CV10 was the only predictor of SRP (P = 0.028). Conclusion The 3DCRT and DVH parameters of stage Ⅲ non-small cell lung cancer are significantly correlated with the occurrence of radiation pneumonitis. V20 and CV10 are the dosimetric indexes for predicting RP and SRP, respectively.