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中华放射肿瘤学杂志
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中华放射肿瘤学杂志  2019, Vol. 28 Issue (10): 735-740    DOI: 10.3760/cma.j.issn.1004-4221.2019.10.004
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非小细胞肺癌术后放疗相关肺毒性风险因素分析
范诚诚1,2, 赵路军1,3, 毕楠1, 惠周光1, 梁军1, 吕纪马1, 王小震1, 葛红2, 王绿化1
1国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科 100021;
2郑州大学附属肿瘤医院 河南省肿瘤医院放疗科 450008;
3天津医科大学附属肿瘤医院放疗科 天津市肿瘤防治重点实验室 300060
Analysis of risk factors of radiation-induced lung toxicity in non-small cell lung cancer patients treated with postoperative radiotherapy
Fan Chengcheng1, 2, Zhao Lujun1, 3, Bi Nan1, Hui Zhouguang1, Liang Jun1, Lyu Jima1, Wang Xiaozhen1, Ge Hong2, Wang Luhua1
1Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021,China;
2Department of Radiation Oncology,Affiliated Cancer Hospital of Zhengzhou University,Henan Cancer Hospital,Zhengzhou 450008, China;
3Department of Radiation Oncology,Tianjin Medical University Cancer Institute and Hospital,Tianjin 300060,China
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摘要 目的 评估手术后接受现代放疗技术的非小细胞肺癌(NSCLC)患者术后有症状的放射性肺毒性(SRILT)发生率及风险因素。方法 回顾性分析2002-2011年于中国医学科学院肿瘤医院行手术治疗且接受术后三维适形或调强放疗的NSCLC患者。采用不良反应评价标准3.0版进行放疗相关肺毒性分级,≥2级定义为SRILT。Logistic回归模型评估潜在的临床因素和剂量学因素。结果 227例患者入组,包括190例肺叶切除术和37例全肺切除术者。23例(10.1%)患者发生了SRILT,均为肺叶切除术后放疗者。放射性肺炎2级17例、3级5例、4级1例。单因素分析结果显示术后同步放化疗、较大的PTV、平均肺剂量、V20-V40与SRILT发生率相关(P=0.015、0.048、<0.001),多因素分析结果显示术后同步放化疗、V20与SRILT发生相关(P=0.017、0.009)。结论 NSCLC术后放疗后SRILT发生率较低,同步放化疗及V20为SRILT发生的影响因素。
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范诚诚
赵路军
毕楠
惠周光
梁军
吕纪马
王小震
葛红
王绿化
关键词 肺肿瘤/外科学肺肿瘤/放射疗法放射性肺损伤    
AbstractObjective To evaluate the incidence and risk factors of symptomatic radiation-induced lung toxicity (SRILT) in non-small cell lung cancer (NSCLC) patients treated with modern radiotherapy after surgery. Methods Clinical data of consecutive NSCLC patients treated with postoperative three-dimensional conformal or intensity-modulated radiotherapy in Cancer Hospital of Chinese Academy of Medical Sciences between November 2002 and December 2011 were retrospectively analyzed. According to the Common Terminology Criteria for Adverse Events (CTCAE, version 3.0), SRILT was defined as ≥grade 2 radiation-induced lung toxicity. Potential clinical risk factors and dosimetric parameters for SRILT were evaluated using logistic regression model. Results Among 227 enrolled patients, 190 cases underwent lobectomy and 37 patients received pneumonectomy. Twenty-three patients (10.1%) developed SRILT after lobectomy. Seventeen patients experienced grade 2 SRILT, 5 cases of grade 3 SRILT and 1 case of grade 4 SRILT. Univariate analysis showed that postoperative concurrent chemoradiotherapy, relatively large PTV, mean lung dose and V20- V40 were significantly correlated with the incidence of SRILT (P=0.015, 0.048 and<0.001). Multivariate analysis demonstrated that postoperative concurrent chemoradiotherapy and V20 were significantly associated with the incidence of SRILT (P=0.017 and P=0.009). Conclusions The incidence of SRILT is relatively low in NSCLC patients after postoperative radiotherapy. Concurrent chemoradiotherapy and V20 are risk factors of SRILT.
Key wordsLung neoplasm/surgery    Lung neoplasm/radiotherapy    Radiation-induced lung injury   
收稿日期: 2018-12-19     
基金资助:国家自然科学基金(81773230)
通讯作者: 王绿化,Email:wlhwq@yahoo.com;葛红,Email:gehong666@126.com   
引用本文:   
范诚诚,赵路军,毕楠等. 非小细胞肺癌术后放疗相关肺毒性风险因素分析[J]. 中华放射肿瘤学杂志, 2019, 28(10): 735-740.
Fan Chengcheng,Zhao Lujun,Bi Nan et al. Analysis of risk factors of radiation-induced lung toxicity in non-small cell lung cancer patients treated with postoperative radiotherapy[J]. Chinese Journal of Radiation Oncology, 2019, 28(10): 735-740.
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