非小细胞肺癌IMRT放疗引起急性重症放射性肺损伤相关因素分析

目的:探讨调强适形放疗（IMRT）及同期化疗的非小细胞肺癌患者发生重度急性放射性肺损伤（SARP）的相关因素。方法:回顾性分析2010年1 月至2014年1 月天津医科大学肿瘤医院行IMRT 放疗及同期化疗的非小细胞肺癌患者临床资料，对影响SARP 发生的临床因素及剂量参数采用单因素和多因素分析。结果:共有2 323 例入组，其中1 241 例发生急性放射性肺损伤（ARP ）。 发生急性重症放射性肺损伤（SARP）患者共185 例，发生率为7.96% ；单因素分析发现性别、病理类型、放射总剂量、V 5（%）、平均剂量与SARP 发生率无关（P > 0.05）；而年龄> 60岁、FEV 1% 预计值、应用多西他赛+ 卡铂/ 顺铂化疗方案、V 20（%）、V 30（%）、双肺平均剂量（MLD ）等与SARP 发生率有关，且差异具有统计学意义（P < 0.05）。 经多因素分析显示年龄＞60岁、应用多西他赛+ 卡铂/ 顺铂化疗方案、V 20（%）、V 30（%）等与SARP 发生率显著相关（P < 0.05），是SARP 发生率的独立影响因素。结论:对非小细胞肺癌患者行IMRT 及同步化疗时，应对高龄及患者多西他赛+ 铂类化疗方案患者和V 20、V 30高剂量的患者，采取必要的预防和治疗措施，减少SARP 的发生，提高患者的生存质量，减少因呼吸衰竭而引起死亡。 

Factors related to severe acute radiation-induced lung injury caused by IMRT for non-small cell lung cancer

Objective:To study the related factors of severe acute radiation-induced lung injury (SAR) caused by IMRT and concurrent chemotherapy for non-small cell lung cancer. Methods:We retrospectively analyzed the data of 2 323 non-small cell lung cancer pa-tients who underwent IMRT radiotherapy and concurrent chemotherapy at the Department of Radiotherapy of Tianjin Medical Univer-sity Cancer Institute and Hospital from January 2010 to January 2014. We analyzed the clinical factors and parameters that affect dose by univariate and multivariate analysis. Results:A total of 2 323 patients enrolled and 1 241 cases suffering from acute radiation-in-duced lung injury with the rate of 53.4%. Only 185 cases suffered from SARP with a rate of 7.96%. Univariate analysis showed that the gender, histopathological type, total radiation dose, V5 (%), and average dose rate are not related to SARP (P>0.05). By contrast an age of>60 years, 1%predicted FEV, docetaxel+carboplatin/cisplatin chemotherapy, V20 (%), V30 (%), and mean lung dose (MLD) are sig-nificantly related to SARP (P<0.05). Multivariate analysis showed that a patient age of>60 years, docetaxel+carboplatin/cisplatin che-motherapy, V20 (%), and V30 (%) are the independent risk factors of SARP. Conclusion:Among the non-small cell lung cancer patients undergoing IMRT radiotherapy and concurrent chemotherapy, further attention should be given to elderly patients, patients receiving docetaxel and platinum chemotherapy, as well as V20 and V30 with high doses. The necessary preventive treatment should be given to reduce the incidence of SARP, improve the quality of life of patients, and reduce the incidence of respiratory failure and mortality.