目的：探讨肺癌三维适形放疗（3D-CRT）和调强放疗（IMRT）诱导肺损伤（RILI）与剂量体积直方图（DVH）参数的关系及两种放疗计划的差异。方法151例肺癌患者分别接受3D-CRT（ n＝90）和IMRT（ n＝61），均给予根治性放疗剂量，采用传统分割照射（1�8～2�0Gy/次，1次/天，5次/周），中位剂量60�0Gy。比较两组发生RILI的差异，并分析两组发生≥2级RILI与DVH参数的关系。结果3D-CRT组≥2级RILI发生率为17�8％，略低于IMRT组的24�6％；≥3级RILI发生率为8�9％，略高于IMRT组的3�3％，差异无统计学意义（ P＞0�05）。单因素分析显示，3D-CRT组V20可增加≥2级RILI的发生风险（ OR＝3�780，P＝0�030）；IMRT组V5、V10、V13、V20和平均照射剂量均可增加≥2级RILI的发生风险（ OR：3�575～6�286，P：0�003～0�045）。多因素分析显示V20是RILI的独立危险因素。结论3D-CRT和IMRT对肺癌患者≥2级RILI的发生率影响不明显，但RILI的发生风险均与V20相关。%Objective To investigate the effect of three-dimensional conformal radiotherapy ( 3D-CRT ) and intensity-modulated radiotherapy( IMRT) on radiation-induced lung injury( RILI) and their relations with parameters of dose volume histograms ( DVH) . Methods One hundred and fifty-one cases of locally advanced lung cancer patients treated with chemoradiotherapy from sin-gle clinical center were enrolled retrospectively, including 90 cases of 3D-CRT and 61 cases of IMRT. All patients were treated with radical radiotherapy dose, 1�8-2�0Gy per fraction, 5 fracions one week, and the median prescribed dose was 60�0Gy. RILI was de-fined according to the National Cancer Institute Common Toxicity Criteria, version 3�0. The incidence of RILI in two groups was calcu-lated and its association with the parameters of DVH were analyzed. Results The incidence of RILI(≥grade 2) in 3D-CRT group was lower than that in IMRT group( 17�8% vs. 24�6%);on the contrary, the incidence of RILI(≥grade 3) in 3D-CRT group was higher than that in IMRT group(8�9% vs. 3�3%). However, there was no statistically significant difference(P>0�05). In 3D-CRT group, V20 would increase the risk of RILI( OR=3�780, P=0�030) , whereas, in IMRT group, V5 , V10 , V13 , V20 and mean lung dose would increase the risk of the RILI( OR=3�575-6�286, P=0�003-0�045) by univariate analysis. Multivariate analysis confirmed V20 was an independent risk factor. Conclusion 3D-CRT and IMRT seemed to have no significant effect on RILI(≥grade 2) , and V20 is tightly correlated with RILI.
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