目的 探讨肺癌患者三维适形放射治疗(3DCRT)所致放射性肺炎(RP)的相关因素.方法 筛选2009年1月至2011年6月住院治疗接受初次肺部3DCRT的肺癌患者,收集其临床资料及放疗物理参数,随访期限至少6个月,RP根据影像学检查及RTOG标准明确,分析上述因素与大于或等于2级RP的关系.结果 入组122例患者中21例发生RP,其中9例发生于放疗中,12例发生于放疗后5个月内.单因素分析差异有统计学意义的相关因素为肿瘤部位(P=0.017)、合并慢性肺病(P=0.044)、放疗前阻塞性肺炎(P=0.000)、照射体积(P=0.000)、照射野的最大直径(P=0.002)、照射野数目(P=0.014)、病侧肺组织平均肺受量(MLD)(P=0.049)及全肺MLD(P=0.05);经过Logistic回归模型多因素分析,放疗前阻塞性肺炎和照射体积是RP发生的显著相关因素(P＜0.05);放疗后有效率为87.7%,1 年生存率为88.52%.结论 RP是多因素综合影响的结果,对放疗前阻塞性肺炎和照射体积较大的患者应优选治疗方案.%Objective To analyze the correlative factors predicting acute radiation pneumonitis (RP) in the treatment of three-dimensional conformal radiotherapy (3DCRT) for lung cancer patients .Methods Lung cancer patients who received lung radiation in our hospital for the first time and didn't undergoing thorax radiation in other site from January 2009 to June 2011 were screened . The clinical data and physical parameters of those patients were collected .The RP was defined by the imaging examination and RTOG standard after a period of six months for follow-up at least .The relationship between radiation pneumonitis which was equal or greater than 2 grade and the factors described above was analyzed .Results 21 patients were found with radiation pneumonitis in 122 cases ,that 9 patients were found during treatment and 12 patients were found in five months after treatment .Single factor analysis: the relative factors were:tumor site(P=0 .017) ,combined with chronic lung disease (P=0 .044),combined obstructive pneumonia before radiation (P=0.000),PTV (P= 0.000), overall diameter (P=0 .002), the number of radiation fields (P=0.014), and the mean lung dose (MLD) in disease lung (P=0 .049) and in total lung (P=0 .05) .The independent factors include combined obstructive pneumonia before radiation and PTV though logistic binary analysis (P＜0 .05) .The effective rate was 87 .7% and 1-year survival was 88 .52% after radiotherapy .Conclusion Patients with obstructive pneumonia before radiation or a larger PTV should be treated with optimal plan .
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