剂量体积参数对晚期放射性心包积液发生的影响

摘要

Objective To evaluate the impact of dose-volume parameters on the incidence of radiation-induced late pericardial effusion in patients with thoracic cancer.Methods Contrast-enhanced chest CT and echocardiography were applied in 49 patients with thoracic cancer who received radiotherapy to investigate the incidence of radiation-induced late pericardial effusion.The heart dose-volume parameters were analyzed to explore the physical influencing factors for radiation-induced late pericardial effusion.Results During the observation period,the incidence rate of radiation-induced late pericardial effusion was 28.6％ (14/49),which included 12 patients with small amount and 2 patients with medium amount of pericardial effusion.The V30 and V35 of the heart were significantly higher in patients with radiation-induced pericardial effusion than in patients without (P =0.035 and 0.038,respectively).Multivariate analysis showed that the V30 of the heart was the influencing factor for radiation-induced late pericardial effusion (P =0.036).The receiver operating characteristic (ROC) curve was used to determine the appropriate threshold for V30.The area under the ROC curve was 0.695,the accuracy of prediction was close to medium level,and the cut-off value was 33.0％.The incidence rate of radiation-induced late pericardial effusion in patients with 33.0％ or greater V30 of the heart was significantly higher than that in patients with less thau 33.0％ V30 (43.5％ vs.15.4％,P =0.030).The sensitivity and specificity of prediction using V30 were both 71.4％.Conclusions Pericardial effusion is a common manifestation of radiation-induced late heart damage.The incidence of pericardial effusion is associated with V30 and V35 of the heart,and V30 is the influencing factor.Increased sample size is needed to validate the results and reach a final conclusion.%目的 探讨胸部肿瘤放疗心脏剂量体积参数对晚期放射性心包积液发生的影响.方法 应用胸部强化CT和超声心动图观察49例胸部肿瘤患者放疗后晚期放射性心包积液发生情况,并对心脏剂量体积参数进行分析,探讨发生晚期放射性心包积液的物理学影响因素.结果 全组患者放射性心包积液发生率为28.6％ (14/49),其中少量12例、中量2例.发生放射性心包积液组心脏V30、V35高于未发生组(P =0.035、0.038).多因素分析显示心脏V30是晚期放射性心包积液发生的影响因素(P=0.036).对心脏V30的ROC曲线下面积为0.695,预测准确性接近中等,界值为33.0％.心脏V30 ≥33.0％组放射性心包积液发生率为43.5％,明显高于＜33.0％组的15.4％(P=0.030).V30预测的敏感性、特异性均为71.4％.结论 心包积液是晚期放射性心脏损伤较为常见的表现类型,心脏V30、V35与放射性心包积液的发生相关,其中心脏V30是晚期放射性心包积液发生的影响因素.但最终结论还需进一步大样本观察结果证实.