非小细胞肺癌适形调强放疗急性放射肺炎DVH预测与临床结果对照分析

目的：利用剂量体积直方图（DVH）不同观测参数预测急性放射肺炎和临床观测结果对照，探讨分析预测准确性。方法：45 例非小细胞肺癌（NSCLC）患者首次接受适形调强放疗，利用 DVH 的单纯 V20（接受 20Gy 的肺体积）预测，V5、V20、V30 预测和 V5、V20、V30、MLD 等三种方法预测不同放射肺损伤。然后它们与 2-12 个月实际临床观察结果，两两对照分析，试图找到最佳的评价标准。结果： 45 例放疗患者急性肺损伤临床观察结果：0 级 10 例、1 级 18 例、2 级 11 例、3 级 5 例、4 级 1 例。DVH 单纯 V20 预测与观察结果对照，0 级和大于 3 级两者对照有统计学意义（P=0.03 和 P=0.01）V5、V20、V30 预测和 V5、V20、V30、平均剂量两组分别与观察结果 X2检验分析，2 级以下没有统计学意义，≥3 级（X2= 6.43 P=0.001；X2= 3.87 P=0.049,）对照有统计学意义。结论：利用 DVH 预测 NSCLC适形调强放疗具有较大的准确性，但患者治疗前的体质或基础肺功能以及后续化学药物使用对放射性损伤也有密切关系。

Analysis of Acute Radiation Pneumonitis Between DVH Prediction and Clinical Results in the Treatment of Non-Small Cell Lung Cancer by Conformal and Intensity Modulated Radiotherapy

Objective To discuss predictive accuracy of acute radiation pneumonitis （RP） for non-small cell lung cancer treated by conformal and intensity modulated radiotherapy based on dose volume histogram （DVH）. Methods 45 patients with small cell lung cancer were treated by conformal and intensity modulated radiotherapy. To gain more predictive accurate values,all predictive results were analyzed by three methods ： V20 （lung volume after receiving 20 Gy） only;V5,V20,V30;and V5,V20,V30,MLD,prediction respectively. Results The RP of grade 0 （10 cases） ,1 （18 cases） ,2 （11 cases） and ≥3 （6 cases） were observed. In the V20 group of DVH,there is a statistical significance in grade 0 and 〉 4 by X2 test （P= 0. 03 and P=0. 01）. In another two groups, there is a statistical significance in grade 3 and 4 by X2 test （X2=6.43,P=0. 001;）C2 ~3.87,P=0. 049,respectively）. Conclusions The V20 of the DVH, combined with V5. V30. MLD of DVH can improve results in predicting RP. The general health conditions of patients and other pharmacotherapy should also be taken into consideration.