局部晚期非小细胞肺癌患者血清TGF-β1及IL-6与放射性肺炎的相关性

摘要

Objective To study the relationship between plasma transform growth factor - beta 1 ( TGF - beta 1 ) and interleukin - 6 ( IL - 6 ) levels, and the dose - volume histogram ( DVH ) parameters or radiation pneumonitis ( RP ) in locally advanced non - small cell lung cancer ( LA - NSCLC ) patients receiving concurrent chemoradiotherapy. Methods A total of 49 LA - NSCLC patients receiving concurrent chemoradiotherapy were allotted into this study. Blood samples were taken before, during radiation and up to 13 weeks after radiation. TGF - beta 1 and IL -6 levels were measured with enzyme - linked immunosorbent assay. DVH parameters were collected and intensity modulated radiation therapy planning was designed with Varian Eclipse DX planning system. RP was graded according to RTOG/EORTC acute radiation pneumonitis criteria. Grade 2 or severer RP was taken as the main end point. Results Eleven patients out of 49 developed RP. TGF - beta 1 levels were not significant different before radiation between the RP and non - RP groups, but significantly higher at multiple time points during radiation and after radiation in RP group ( P ＜ 0. 05 ). IL - 6 levels were significantly higher before radiation, during radiation, and after radiation in RP group ( P ＜ 0. 05 ). There was no significant difference between the RP and non - RP group in DVH parameters. Conclusion TGF - beta 1 and IL - 6 levels can be possibly applied in prediction of RP for LA - NSCLC patients receiving concurrent chemoradiotherapy.%目的 评价局部晚期非小细胞肺癌(LA-NSCLC)同步放化疗患者放疗前、放疗中和放疗后血清转化生长因子-β1(TGF-β1)、白细胞介素-6(IL-6)的变化及调强放射治疗计划剂量体积直方图(DVH)参数与放射性肺炎的相关性.方法 49例行同步放化疗的LA-NSCLC患者,在治疗前、治疗过程中每周及治疗后第13周采用ELISA法检测血清TGF-β1和IL-6水平.应用Varian Eclipse DX计划系统,设计并评估调强放射治疗计划,并采集相关物理学参数.放射性肺炎按RTOG急性放射性肺炎标准评价,评价终点为≥2级放射性肺炎.结果 11例发生了放射性肺炎.放射性肺炎组放疗前血清TGF-β1浓度与无放射性肺炎组比较差异无统计学意义,有放射性肺炎组在放疗中各个时间点和放疗后均高于无放射性肺炎组(P<0.05);血清IL-6浓度在放疗前、放疗中各个时间点和放疗后有放射性肺炎组均高于无放射性肺炎组(P<0.05);放射性肺炎组DVH相关参数(包括肿瘤靶区的平均剂量、最大剂量、最小剂量,肺脏V5、V10、V20、平均剂量、正常组织并发症概率,食管V45,心脏平均受照剂量及脊髓最大受照剂量)与放射性肺炎组比较差异无统计学意义.结论 LA-NSCLC患者同步放化疗时,在使用DVH相关参数严格限制正常组织受照剂量的同时,血清TGF-β1和IL-6可以作为放射性肺炎的预测因子.