不同放化疗治疗模式对肺癌患者放射性肺炎发生的影响

刘锐锋; 魏世鸿; 张秋宁; 罗宏涛; 董玉梅; 王小虎

doi:10.3971/j.issn.1000-8578.2018.18.0065

不同放化疗治疗模式对肺癌患者放射性肺炎发生的影响

Influence of Different Radio-chemotherapy Modes for Incidence of Radiation Pneumonitis in Patients with Lung Cancer

摘要

摘要:
目的比较肺癌放疗患者不同放化疗治疗模式下2级以上放射性肺炎（RP）发生的差异，以及临床治疗特征对RP发生的影响。
方法回顾性分析自2014年1月至2016年1月在我院行放化疗综合治疗的肺癌患者136例，按期随访并复查肺功能、胸部CT，按RTOG急性放射肺炎评价标准对肺损伤分级进行评价，分析临床特征及治疗模式对RP发生的影响。
结果 ≥2级RP 36例，发生率为26.5%。临床特征方面，粉尘接触史和病理类型与RP发生有一定相关性（P=0.048, 0.047），其余指标方面差异均无统计学意义。治疗模式方面，序贯放化疗与同步放化疗比较，在总RP发生、2级和3级RP发生率方面差异均无统计学意义，而≥4级RP发生率两组比较差异有统计学意义（6.7% vs. 0, P=0.05）。不同化疗方案之间比较在≥2级RP发生方面差异无统计学意义。RP严重程度与总化疗周期数及诱导化疗周期数呈显著正相关（P=0.000）。
结论粉尘接触史和病理类型是临床特征方面增加RP发生的独立因素。不同治疗模式对RP的发生有一定的影响，其中与患者化疗周期数密切相关，特别是总化疗周期或诱导化疗周期。

Abstract:
Objective To compare the difference of different radio-chemotherapy modes and clinical characters for more than grade 2 radiation pneumonitis (RP) incidence in patients with lung cancer.
Methods We retrospectively analyzed the 136 patients with lung cancer who were treated with radio-chemotherapy in our hospital from January 2014 to January 2016. Following-up was undergone regularly after treatment. RTOG standard of acute radiation pneumonia was applied to evaluate lung injury grade. We also analyzed the effect of clinical character and treatment modes on RP.
Results There were 36 cases diagnosed as ≥grade 2 RP, and the occurrence rate was 26.5%. The patients with dust exposure history(P=0.048) and NSCLC pathology type (P=0.047) had a higher RP incidence, while other characters had no statistical difference. Comparing between concomitant chemoradiation group and sequential chemoradiation group, there was statistical difference in the incidence of ≥grade 4 RP (6.7% vs. 0, P=0.05), however, no statistical difference in overall RP, grade 2 or grade 3 RP. There was no statistical difference among different chemotherapy regimens to ≥grade 2 RP. There was significantly positive correlation of RP severity with the total chemotherapy cycles or induction chemotherapy cycles(P=0.000).
Conclusion Dust exposure history and pathology type are two clinical character factors to influence the incidence of RP. RP is closely related to the chemotherapy cycles, especially in total chemotherapy cycles or induction chemotherapy cycles.

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