Abstract：Objective To investigate the factors associated with radiation-induced lung injury (RILI) caused by radiation therapy for lung cancer patients in Tibetan Plateau, China. Methods A total of 262 patients with non-small cell lung cancer (NSCLC) confirmed by pathology or cytology from April 2012 to February 2016, consisting of 138 native Tibetans living at an elevation over 3000 meters and 124 non-native Tibetans or non-Tibetan people, were analysed. All patients received intensity-modulated radiotherapy±chemotherapy and underwent CT follow-up for over 6 months. For patients with grade ≥2 RILI, the associations of ethnicity, age, sex, Karnofsky Performance Scale (KPS) score, clinical stage, chemotherapy, and smoking history with RILI were analyzed. For two groups of patients, native Tibetan population and non-native Tibetan population, the associations of sex, smoking history, chemotherapy, and radiation dose with RILI were analyzed. Radiation dose-volume parameters were compared using the chi-square test or ’s's exact test, and their correlations were analyzed using the Person correlation test;a multivariate analysis was performed using the logistic regression model. Results For the 262 NSCLC patients, ethnicity (P=0.040), sex (P=0.001), KPS score (P=0.026), presence or absence of smoking history (P=0.014), minimum lethal dose (P=0.037), V5(P=0.000), and V20(P=0.025) were found to be associated with the development of RILI. Further analysis showed that only the smoking history (P=0.013) was significantly correlated with demographic composition. And there was no significant relationship between radiation dose for different groups and the incidence of RILI (all P=>0.05). Conclusions Native Tibetan patients with NSCLC are more susceptible to RILI.
Zhang Kuan,Cui Ying,Ma Shengchun et al. Sensitivity analysis for radiation-induced lung injury caused by radiotherapy for lung cancer patients in Tibetan Plateau, China [J]. Chinese Journal of Radiation Oncology, 2017, 26(4): 390-393.
[1] Yano H,Hamanaka R,Nakamura M,et al. Smad,but not MAPK,pathway mediates the expression of type I collagen in radiation induced fibrosis[J].Biochem Biophys Res Commun,2012,418(3):457-463.DOI:10.1016/j.bbrc.2012.01.039 [2] 闵茜.放射性肺损伤发生机制的研究进展[J].肿瘤学杂志,2016,22(2):88-92.DOI:10.11735/j.issn.1671-170X.2016.02.B003.Min Q.Mechanisms of radiation-induced lung injure[J].J Oncol,2016,22(2):88-92.DOI:10.11735/j.issn.1671-170X.2016.02.B003 [3] 陈曦,赵路军,徐利明,等.氧化应激在放射性肺损伤中的相关研究进展[J].中华放射医学与防护杂志,2016,36(4):312-315.DOI:10.3760/cma.j.issn.0254-5098.2016.04.017. Chen X,Zhao LJ,Xu LM,et al. Research progress of oxidative stress in radiation-induced lung injury[J].Chin J Radiol Med Prot,2016,36(4):312-315.DOI:10.3760/cma.j.issn.0254-5098.2016.04.017 [4] 汪晨净,南晓东,景志敏.不同海拔高度世居健康藏族人群体内氧自由基代谢的研究[J].环境与健康杂志,2007,24(11):907-909.DOI:10.3969/j.issn.1001-5914.2007.11.021. Wang CJ,Nan XD,Jing ZM.Study of oxygen free radical metabolism of healthy native tibetans at different altitudes[J].J Environ Health,2007,24(11):907-909.DOI:10.3969/j.issn.1001-5914.2007.11.021 [5] Kwapiszewska G,Chwalek K,Marsh LM,et al. BDNF/TrkB signaling augments smooth muscle cell proliferation in pulmonary hypertension[J].Am J Pathol,2012,181(6):2018-2029.DOI:10.1016/j.ajpath.2012.08.028 [6] 陈昌贵,吴天一.肺动脉平滑肌细胞与低氧肺血管重构[J].医学研究杂志,2013,42(11):10-13. Chen CG,Wu TY.Pulmonary arterial smooth muscle cells and hypoxic pulmonary vascular remodeling[J].J Med Res,2013,42(11):10-13 [7] 刘丽萍,阿祥仁.高原红细胞增多症患者体内氧自由基代谢的研究[J].临床荟萃,2003,18(6):316-317.DOI:10.3969/j.issn.1004-583X.2003.06.006. Liu LP,A XR.Study of metabolism of free radicals in patients with high altitude polycythemia[J].Clin Focus,2003,18(6):316-317.DOI:10.3969/j.issn.1004-583X.2003.06.006 [8] 杨桂英,熊元治,马颖才,等.三个不同海拔地区世居藏族人群胃组织内四种体液因子含量变化分析[J].J High Altit Med,2013,23(2):34-35. Yang GY,Xiong YZ,Ma YC,et al. Analysis of the changes of four kinds of humoral factors in the gastric tissues of Tibetan people in different altitude regions of the world in the last three years[J].高原医学杂志,2013,23(2):34-35 [9] 关巍,许金花,王晋,等.低氧诱导因子-1α、血管内皮生长因子及胎盘生长因子在不同海拔世居藏族及移居汉族青年中的水平及意义[J].实用医学杂志,2013,29(23):3889-3892.DOI:10.3969/j.issn.1006-5725.2013.23.037. Guan W,Xu JH,Wang J,et al. Levels and significance of hypoxia inducible factor-1 alpha, vascular endothelial growth factor and placental growth factor in Tibetan and Han Chinese immigrants at different altitudes[J].J Pract Med,2013,29(23):3889-3892.DOI:10.3969/j.issn.1006-5725.2013.23.037. [10] Petousi N,Robbins PA.Human adaptation to the hypoxia of high altitude:the Tibetan paradigm from the pregenomic to the postgenomic era[J]. J Appl Physiol,2014,116(7):875-884.DOI:10.1152/japplphysiol.00605.2013. [11] 王静波,曹建忠,姬巍,等.局部晚期非小细胞肺癌三维放疗后放射性肺损伤风险因素分析[J].中华放射肿瘤学杂志,2012,21(2):114-120.DOI:10.3760/cma.j.issn.1004-4221.2012.02.006. Wang JB,Cao JZ,Ji W,et al. Risk factors for radiation induced lung toxicity in locally advanced non-small cell lung cancer treated with three-dimensional radiotherapy[J].Chin J Radiat Oncol,2012,21(2):114-120.DOI:10.3760/cma.j.issn.1004-4221.2012.02.006. [12] 张晓晶,孙建国,孙洁,等.肺癌三维适形放疗所致放射性肺炎的相关因素分析[J].重庆医学,2012,41:1065-1068.DOI:10.3969/j.issn.1671-8348.2012.11.008. Zhang XJ,Sun JG,Sun J,et al. Analysis of factors predicting radiation pneumonitis in the treatment of three-dimensional conformal radiotherapy for lung cancer[J].Chongqing Med J,2012,41:1065-1068.DOI:10.3969/j.issn.1671-8348.2012.11.008. [13] Khalil AA,Hoffmann L,Moeller DS,et al. New dose constraint reduces radiation-induced fatal pneumonitis in locally advanced non-small cell lung cancer patients treated with intensity-modulated radiotherapy[J]. Acta Oncol,2015,54(9):1343-1349.DOI:10.3109/0284186X.2015.1061216. [14] Beall CM,Laskowski D,Erzurum SC.Nitric oxide in adaptation to altitude[J]. Radic Biol Med,2012,52(7):1123-1134.DOI:10.1016/j.freeradbiomed.2011.12.028. [15] Kabolizadeh P,Kalash R,Huq MS,et al. Dosimetric definitions of total lung volumes in calculating parameters predictive for radiation-induced pneumonitis[J]. Am J Clin Oncol,2015,38(4):401-404.DOI:10.1097/COC.0b013 e3182a2588f. [16] Vogelius IS,Westerly DC,Cannon GM,et al. Intensity-modulated radiotherapy might increase pneumonitis risk relative to three-dimensional conformal radiotherapy in patients receiving combined chemotherapy and radiotherapy:a modeling study of dose dumping[J]. Int J Radiat Oncol Biol Phys,2011,80(3):893-899.DOI:10.1016/j.ijrobp.2010.12.073.
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