摘要
目的在局部晚期周围型非小细胞肺癌患者放疗中,放射性肺损伤是限制肿瘤区域放射剂量提高的主要不良反应。本研究探讨局部晚期非小细胞肺癌(locally advanced none small cell lung cancer,LA-NSCLC)调强放疗中大体肿瘤靶区(gross tumor volume,GTV)体积变化以及双肺V5、V20、V30和肺平均剂量(mean lung dose,MLD)与相关因素之间的拟合公式,试图减少主观因素对肺剂量影响。方法选取2015-06-21-2018-06-21西南医科大学附属医院肿瘤科接受调强放疗的48例LA-NSCLC患者,采集放疗前与放疗后影像数据,观察GTV变化情况。采用机械随机抽样法,将48例患者分为数据采集组(n=33)与数据验证组(n=15),在数据采集组中寻求肺V5、V20、V30以及MLD相关因素,建立拟合公式,并在数据验证组中对拟合公式进行验证。结果调强适形放射治疗(intensity modulated radiation therapy,IMRT)前LA-NSCLC患者GTV体积为(79.7±118.8)cm3,IMRT后LA-NSCLC患者GTV体积为(50.3±75.6)cm3。GTV体积平均退缩36.8%。肺V5、V20、V30和MLD分别与计划靶区(planning target volume,PTV)、肺的相交体积(Voverlap)和PTV在患者前后、左右、头脚三个方向的最大长径之间均存在正相关性,r取值为0.600~0.755,均P<0.05;使用多元线性拟合对上述因素进行拟合得出公式,决定系数r2分别为0.854、0.935、0.966和0.973,均P<0.05。数据验证组患者调强计划V5、V20、V30和MLDδ1均>δ2,P值分别为0.024、0.045、0.007和0.045,差异均有统计学意义。结论本研究通过分析得出LA-NSCLC调强放疗中影响肺V5、V20、V30及MLD的相关因素,建立拟合公式,在制作调强放疗计划前预测出肺受量,作为放疗计划制作剂量优化参考。患者放疗期间GTV体积退缩明显,及时修改放疗计划,有助于减小肺的受量。
OBJECTIVE In patients with locally advanced peripheral non-small cell radiotherapy,radiation-induced lung injury is the main toxic side effect that limits the radiation dose in the tumor area.This study studies the volume changes of gross tumor target area(GTV)in locally advanced non-small cell lung cancer(LA-NSCLC)during intensitymodulated radiotherapy(IMRT)and the fitting formulas between V5,V20,V30 of both lungs and mean lung dose(MLD)of lung and related factors in an attempt to reduce the subjective factors on the lung dose.influences.METHODS Totally 48 patients with locally advanced peripheral NSCLC,who underwent IMRT in our department between 2015 and 2018,were divided into two groups by mechanical random sampling,one for data collection(n=33)and the other for data validation(n=15).For the data collection group,we establish a correlation formula by the data related to lung V5,V20,V30 and MLD.Then verify the correlation formula in the data validation group.RESULTS The GTV volume of LA-NSCLC patients before IMRT was(79.7±118.8)cm3,and that of LA-NSCLC patients after IMRT was(50.3±75.6)cm3.The average volume shrinkage of GTV was 36.8%.There were significant correlation between lung V5,V20,V30 and MLD with the overlapped volume of PTV and lung(Voverlap)and the maximum PTV diameter in the left-right,anterior-posterior and cranial-caudal directions respectively(The r2 values were 0.854,0.935,0.966 and 0.973,respectively).Data validation group V5,V20,V30 and MLD delta 1 were greater than Delta 2,the difference was statistically significant,Pvalues were 0.024,0.045,0.007 and 0.045,respectively.CONCLUSIONS This study analyzes the factors affecting lung V5,V20,V30,and MLD and establishes a fitting formula.We can predict lung V5,V20,V30,and MLD according to the relevant mathematical model fitted in this study before the radiotherapy planning.During radiotherapy,the volume of GTV retracts obviously.Modifying the radiotherapy plan in time will help to reduce the lung volume.
作者
陈斌
石翔翔
唐涛
CHEN Bin;SHI Xiang-xiang;TANG Tao(Department of Radiation Oncology,Affiliated Hospital of Southwest Medical University,Luzhou 646000,P.R.China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2020年第14期1166-1170,共5页
Chinese Journal of Cancer Prevention and Treatment
关键词
调强放疗
非小细胞肺癌
肺受量
肿瘤靶区
intensity modulated radiationtherapy
None Small Cell Lung Cancer
Lung Dose
Predict
