摘要
[目的]探讨肺癌患者放疗后放射性肺炎发病相关因素,寻找合理的预测指标。[方法]对118例接受根治性放疗的非小细胞肺癌患者进行随访。处方剂量60～75Gy,以患者临床症状、胸部X线片、薄层CT了解患者有无放射性肺炎发生,对患者临床资料和治疗计划等指标进行单因素及多因素分析评价放射性肺炎相关因素。[结果] 118例患者经治疗后37例出现≥2级的急性放射性肺炎,占31.35%;临床因素中放疗合并化疗、放疗前合并COPD以及有吸烟史对放射性肺炎发生率有显著性影响(P<0.05)。GTV、V5等10项放疗剂量学指标在有无放射性肺炎患者间差异均有统计学意义(P<0.05);将这些物理指标分层分析显示,当GTV>135cm、V_(10)>47%、V_(20)>25%、V_(25)>22%、V_(30)>18%、V_(35)>15%或者V_(40)>13%时,放射性肺炎的发生率增高(P<0.05)。放疗前合并有COPD、双肺V_(10)>47%,V_(30)>18%和同期放化疗为放射性肺炎发生的独立影响因素(均P<0.05)。[结论]伴有肺部慢性疾病的患者是放射性肺炎发生的独立影响因素。对肺部有慢性阻塞性肺病的患者要严格控制正常组织受量,使V_(20)≤25%,V_(30)≤18%。
[Objective] To investigate the factors related to the radiation pneumonia in lung cancer patients. [Methods] The clinical data of 118 patients with locally advanced non-small cell lung cancer(NSCLC) undergoing radical radiotherapy were reviewed. The radiation pneumonia was confirmed by clinical symptoms,chest X-ray and thin-layer CT examination. The factors related to the occurence of radiation pneumonia were examined with univariate and multivariate regression analyses. [Results] Thirty-seven cases of acute radiation pneumonia after radiotherapy were confirmed in 118 patients(31.4%). Univariate analysis showed that radiation pneumonia was significantly associated with concurrent radiochemotherapy,COPD and smoking history(P<0.05);patients with GTV>135cm,V10>47%,V25>22%,V30>18%,V35>15% or V40>13% had an increased incidence of radiation pneumonia(all P<0.05). Multivariate analysis showed that complication with COPD,V10>47%,V30>18% and concurrent radiochemotherapy were independent risk factors of radiation pneumonia(P<0.05). [Conclusion ] Underlying chronic lung disease would increase the risk of radiation pneumonia in patients with locally advanced NSCLC undergoing radiotherapy,which indicating that the radiation for the normal tissue volume should be strictly controlled(V20≤25% and V30≤18%).
作者
宋慧胜
王馨
汤锐明
潘辉林
冯正富
SONG Hui-sheng;WANG Xin;TANG Rui-ming;PAN Hui-lin;FENG Zheng-fu(The Sixth Affiliated Hospital of Guangzhou Medical University,Qingyuan 511518,China)
出处
《肿瘤学杂志》
CAS
2019年第1期42-46,共5页
Journal of Chinese Oncology
关键词
肺癌
放射治疗
放射性肺炎
危险因素
lung cancer
radiotherapy
radiation pneumonia
risk factors
