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肺低剂量区体积预测胸中下段食管癌放射性肺炎的价值

曹彦坤, 沈文斌, 祝淑钗

曹彦坤, 沈文斌, 祝淑钗. 肺低剂量区体积预测胸中下段食管癌放射性肺炎的价值[J]. 肿瘤防治研究, 2015, 42(01): 32-36. DOI: 10.3971/j.issn.1000-8578.2015.01.008
引用本文: 曹彦坤, 沈文斌, 祝淑钗. 肺低剂量区体积预测胸中下段食管癌放射性肺炎的价值[J]. 肿瘤防治研究, 2015, 42(01): 32-36. DOI: 10.3971/j.issn.1000-8578.2015.01.008
CAO Yankun, SHEN Wenbin, ZHU Shuchai. null[J]. Cancer Research on Prevention and Treatment, 2015, 42(01): 32-36. DOI: 10.3971/j.issn.1000-8578.2015.01.008
Citation: CAO Yankun, SHEN Wenbin, ZHU Shuchai. null[J]. Cancer Research on Prevention and Treatment, 2015, 42(01): 32-36. DOI: 10.3971/j.issn.1000-8578.2015.01.008

肺低剂量区体积预测胸中下段食管癌放射性肺炎的价值

详细信息
    作者简介:

    曹彦坤(1977-),女,硕士,副主任技师,主要从事放射物理工作

    通讯作者:

    祝淑钗,E-mail: cykun888@163.com

  • 中图分类号: null

  • 摘要: 目的 明确肺低剂量区体积在预测接受放射治疗的胸中下段食管癌患者出现急性放射性肺炎(radiation pneumonitis, RP)的价值。方法 对205例接受放射治疗并符合入组条件的胸中下段食管癌患者发生RP的情况进行分析,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,评价肺低剂量区体积指标的价值。结果 全组患者出现≥2级RP的患者为60例占29.27%(60/205),其中2级48例(23.41%),3级10例(4.88%),4级2例(0.98%)。单因素分析结果显示食管癌病变X 线长度、GTV最大横径、GTV长度、射野数、肺MLD、GTV体积、PTV体积、肺V5、肺V10和肺V15均影响患者≥2级RP的发生。多因素分析结果显示射野数、肺MLD及肺V5为患者≥2级RP发生的独立预测影响因素。ROC曲线分析结果显示本组患者肺V5取值为51.17%为预测放射性肺炎的效能值。结论 肺低剂量区体积V5为接受放疗的胸中下段食管癌患者发生≥2级RP的重要预测因素,建议在以后制定胸中下段食管癌的放射治疗计划时应该予以重视,取值应≤51.17%。

     

    Abstract: Objective To clear and definite the predictive value of low dose volume of lung on acute radiation pneumonitis(RP) in patients with middle and lower thoracic esophageal cancer. Methods Two hundred and five patients with middle and lower thoracic esophageal cancer treated with radiotherapy were followed up. The clinical factors and treatment parameters were analyzed by univariate and multivariate analysis. Indexes of low dose volume of lung were evaluated. Results The acute RP with ≥grade 2 were observed in 60 patients(29.27%, 60/205). The incidence of grade 2, 3 and 4 were 23.41%(48/205), 4.88%(10/205) and 0.98%(2/205), respectively. Univariate analysis showed that the X-ray length of esophagus cancer lesion,the maximum transverse diameter of GTV, GTV length, radiation fields, MLD, GTV volume, PTV volume and lung V5-V15 all had significant relationship with ≥grade 2 acute RP. Multivariate analysis showed that radiation fields, MLD and Lung V5 were the independent risk factors for ≥grade 2 acute RP. ROC curves showed that the efficiency value to predict RP for V5 values was 51.17%. Conclusion The low dose volume of V5 is effective in predicting ≥grade 2 acute RP in patients with middle and lower thoracic esophageal cancer. We recommend that it should be attached importance in the radiotherapy plan for middle and lower esophageal cancer in the future and the effective value should be ≤51.17%.

     

  • [1] Xu G, Li XM. The advances in the study of radiation pneumonitis[J]. Zhong Liu Fang Zhi Yan Jiu, 2005, 32(4): 25 1-3.[徐钢, 李先明. 放射性肺炎的研究进展[J]. 肿瘤防治研 究, 2005, 32(4): 251-3.]
    [2] Ding W, Guo Y. Radiation induced lung injury[J]. Yi Xue Ying Xiang Xue Za Zhi, 2005, 15(9): 813-6.[丁文, 郭岩. 放射性肺损 伤[J] 医学影像学杂志, 2005, 15(9): 813-6.]
    [3] Yin WB, Gu XZ. Radiation oncology (third edition) [M]. Beijing: Peking Union Medical College Press, 2002:1108-10.[殷蔚伯, 谷 铣之. 肿瘤放射治疗学(第3版)[M]. 北京: 中国协和医科大学 出版社, 2002: 1108-10.]
    [4] Hirota S, Tsujino K, Endo M, et al. Dosimetric predictors of radiation esophagits in patients treated for non-small-cell lung cancer with carboplatin/paclitaxel/radiotherapy[J]. Int J Radiat Oncol Biol Phys, 2001, 51(2): 291-5.
    [5] Miller AB, Hoogstraten B, Staquet M, et al. Reporting results of cancer treatment[J]. Cancer, 1981, 47(1): 207-14.
    [6] Hart JP, McCurdy MR, Ezhil M, et al. Radiation pneumonitis: correlation of toxicity with pulmonary metabolic radiation response[J]. Int J Radiat Oncol Biol Phys, 2008, 71(4): 967-71.
    [7] Asakura H, Hashimoto T, Zenda S, et al. Analysis of dose-volume histogram parameters for radiation pneumonitis after definitive concurrent chemoradiotherapy for esophageal cancer[J]. Radio Oncol, 2010, 95(2): 240-4.
    [8] Shen WB, Zhu SC, Gao HM, et al. Low dose volume histogram analysis of the lungs in prediction of acute radiation pneumonitis in patients with esophageal cancer treated with three-dimensional conformal radiotherapy[J]. Zhonghua Zhong Liu Za Zhi, 2013, 35 (1): 45-9.[沈文斌, 祝淑钗, 高红梅, 等. 肺脏低剂量区体积预 测食管癌三维适形放疗所致急性放射性肺炎的价值[J]. 中华肿 瘤杂志, 2013, 35(1): 45-9.]
    [9] Shen WB, Zhu SC, Li R, et al. Predictors of radiation-induced lung toxicties in patients with thoracic middle and lower esophageal cancer treated with three-dimensional conformal radiotherapy[J]. Zhonghua Fang She Zhong Liu Xue Za Zhi, 2007, 16(5): 33 5-40.[沈文斌, 祝淑钗, 李任, 等. 胸中下段食管癌三维适形放 疗所致放射性肺损伤相关因素分析[J]. 中华放射肿瘤学杂志, 20 07, 16(5): 335-40.]
    [10] Zhu SC, Shen WB, Liu ZK, et al. Dosimetric and clinical predictors of radiation-induced lung toxicity in esophageal carcinoma[J]. Tumori, 2011, 97(5): 596-602.
    [11] Wan L, Li XN, Lv DJ, et al. Low dose volume of the lung in prediction of acute radiation pneumonitis[J]. Zhonghua Fang She Zhong Liu Xue Za Zhi, 2010, 19(4): 296-300.[王澜, 李晓宁, 吕 冬捷, 等. 肺低剂量区体积预测急性放射性肺炎价值探讨[J]. 中 华放射肿瘤学杂志, 2010, 19(4): 296-300.]
    [12] Kumar G, Rawat S, Puri A, et al. Analysis of dose-volume parameters predicting radiation pneumonitis in patients with esophageal cancer treated with 3D-conformal radiation therapy or IMRT[J]. Jpn J Radiol, 2012, 30(1): 18-24.
    [13] Wang SL, Liao Z, Vaporciyan AA, et al. Investigation of clinical and dosimetric factors associated with postoperative pulmonary complications in esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery[J]. Int J Radiat Oncol Biol Phys, 2006, 64(3): 692-9.
    [14] Tanabe S, Myojin M, Shimizu S,et al. Dose-volume analysis for respiratory toxicity in intrathoracic esophageal cancer patients treated with definitive chemoradiotherapy using extended fields[J]. J Radiat Res, 2013, 54(6): 1085-94.
    [15] Yamashita H, Nakagawa K, Nakamura N, et al. Exceptionally high incidence of symptomatic grade 2-5 radiation pneumonitis after stereotactic radiation therapy for lung tumors[J]. Radiat Oncol, 20 07, 2: 21.
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出版历程
  • 收稿日期:  2013-10-23
  • 修回日期:  2013-11-12
  • 刊出日期:  2015-01-24

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