调强放射治疗肺癌患者发生放射性肺损伤的危险因素分析

摘要

目的：探讨肺癌调强放疗后放射性肺损伤发生的危险因素。方法：选择我院放疗科收治的非小细胞肺癌患者190例。患者以调强放射治疗，部分患者联合化疗，对患者随访期间发生的放射性肺损伤的危险因素进行单因素和多因素分析。结果：本组190例患者，调强放疗后发生肺损伤40例，发生率为21．1％，肺损伤率随参数双侧肺M LD、患侧肺M LD、患侧肺V20的增加而增加（ P＜0．05）。G T V≥125cm2者肺损伤率明显高于G T V＜125cm2者（ P＜0.05）。双侧肺M LD与患侧肺M LD、患侧肺V20间有显著相关性（ P＝0．00）；患侧肺M LD与患侧肺V20间有明显相关性（ P＝0．00）。Logistic多因素分析显示，患侧肺MLD是放射性肺损伤独立危险因素（P＝0．00）。结论：全肺MLD、患肺MLD或患肺V20、GTV与放射性肺损伤有一定的关系，因此实施放疗计划前，应充分评估剂量体积参数，结合GTV等因素，以利于提高肿瘤控制率，减少肺损伤。%Objective :To explore the risk factors of radiation‐induced lung injury among lung cancer patients who were treated with intensity‐modulated radiotherapy(IMRT) .Methods:190 patients with non small cell lung cancer who was treated in radiotherapy department of our hospital .They were treated with IMRT ,some patients were treated with IM‐RT combined with chemotherapy ,risk factors of radiation‐induced lung injury during follow‐up did univariate and mult‐ivariate analysis .Results:Among 190 patients ,there were 40 cases who had occurred radiation‐induced lung injury ,the incidence rate was 21 .1% ,the lung injury rate increased with parameters ,such as MLD of bilateral lung ,MLD of af‐fected side lung ,V20 of affected side lung increasing (P<0 .05) .The lung injury rate of patients with GTV ≥ 125cm2 was significantly higher than that of GTV<125cm2 (P<0 .05) .There was significant correlation between MLD of bi‐lateral pulmonary and MLD of affected side pulmonary ,V20 of affected side pulmonary (P=0 .00);there was significant correlation between MLD of affected side pulmonary and V20 of affected side pulmonary (P=0 .00);Logistic multivari‐ate analysis showed that the MLD of affected side pulmonary was an independent risk factor of radiation‐induced lung injury(P=0 .00) .Conclusion:The MLD of all lung ,MLD of affected side pulmonary ,V20 of affected side pulmonary , GTV and radioactive lung injury has certain relation ,so before implementation of radiotherapy plan ,the dose volume parameters should be assessed ,GTV and other factors were combined with ,in order to improve tumor control rate ,re‐duce lung injury .