摘要
目的探讨Lyman-Kutcher-Burman(LKB)正常组织并发症概率(NTCP)模型对食管癌调强放疗所致放射性肺损伤(RILI)的预测价值。方法收集2013年1月至2017年12月于本院接受调强放疗的182例食管癌患者(单一放疗131例、同步放化疗51例),根据剂量体积直方图用最大似然法估算LKB NTCP模型的参数值,完成治疗计划后分析不同程度RILI的肺平均剂量(Dmean)、V5、V10、V15、V20、V25、V30、V35、V40、NTCP值和肿瘤长度,采用Logistic回归进行多因素分析,受试者工作特征(ROC)曲线评价LKB NTCP模型在预测食管癌调强放疗中RILI发生风险的效能。结果全组随访6.0~56.0个月,中位随访15.0个月,未发生RILI的患者均随访超过6个月。182例中26例出现≥2级RILI,发生率为14.29%(26/182)。LKB NTCP模型的参数:n=0.13、n=1、TD50=20.3 Gy。单因素分析提示RILI与全肺Dmean、V10、V15、V20、V30、肿瘤长度和NTCP值有关(P<0.05),进一步多因素分析发现仅V20(OR=4.758,95%CI:1.475~15.350)和NTCP值(OR=6.128,95%CI:2.168~17.321)为与RILI发生相关的独立因素(P<0.05)。ROC曲线结果显示LKB NTCP模型(m=0.13、n=1、TD50=20.3 Gy)的曲线下的面积为0.858。结论新的LKB NTCP模型在预测食管癌调强放疗所致RILI的发生中有一定的价值,但应用于临床还需要进一步深入探讨。
Objective To explore the value of Lyman-Kutcher-Burman(LKB)normal tissue complication probability(NTCP)model in predicting radiation-induced lung injury(RILI)induced by intensity-modulated radiotherapy(IMRT)for esophageal cancer.Methods From January 2013 to December 2017,182 cases of esophageal cancer were enrolled and received IMRT.One hundred and thirty-one cases received single radiotherapy and remaining 51 cases received concurrent radiotherapy and chemotherapy.The parameters of LKB NTCP model were estimated by maximum likelihood method according to dose volume histogram.After the completion of treatment plan,lung mean dose(Dmean),V5,V10,V15,V20,V25,V30,V35,V40,NTCP value and tumor length of patients with different degrees of RILI were analyzed.Logistic regression analysis was carried out for multivariate analysis.Receiver operating characteristic(ROC)curve was used for analyzing the value of LKB NTCP model in predicting the risk of RILI in IMRT.Results All the patients were followed up for 6.0-56.0 months with the median follow-up of 15.0 months,and patients without RILI were followed up for more than 6 months.Among the 182 cases,26 cases had grade 2 and above RILI with the incidence of 14.29%(26/182).The LKB model parameters were m=0.13,n=1 and tolerance dose for 50%complication risk for whole organ irradiated uniformly TD50=20.3 Gy.Univariate analysis showed that RILI was related to Dmean,V10,V15,V20,V30,tumor length and NTCP value(P<0.05).Further multivariate analysis showed that only V20(OR=4.758,95%CI:1.475-15.350)and NTCP value(OR=6.128,95%CI:2.168-17.321)were independent factors related to RILI(P<0.05).ROC curve showed that the area under the curve of LKB NTCP model(m=0.13,n=1 and TD50=20.3 Gy)was 0.858.Conclusion The new LKB NTCP model has some value in predicting the occurrence of RILI after radiotherapy for esophageal cancer,but it needs to be further explored in clinical application.
作者
黄华忠
李小会
万文俊
尹宜发
欧宝权
夏丹
李鑫
邓飞
HUANG Huazhong;LI Xiaohui;WAN Wenjun;YIN Yifa;OU Baoquan;XIA Dan;LI Xin;DENG Fei(Department of Radiation and Chemotherapy, the Second People's Hospital of China Three Gorges University, Yichang 443000, China)
出处
《临床肿瘤学杂志》
CAS
北大核心
2020年第5期446-450,共5页
Chinese Clinical Oncology
基金
宜昌市科学研究与开发项目卫生课题(A13301-36)。
关键词
食管癌
调强放疗
正常组织并发症概率
放射性肺损伤
Esophageal cancer
Intensity modulated radiation therapy
Normal tissue complication probability
Radiation induced lung injury
