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乳腺癌术后放疗致放射性肺炎的临床分析 总被引:4,自引:0,他引:4
目的 探讨乳腺癌术后放疗引起放射性肺炎的相关临床因素.方法 回顾性分析226例术后放疗的乳腺癌,观察放疗的照射野、照射剂量,使用化疗药物的时间、种类,内分泌治疗,患者的年龄和肺部基础病变与放射性肺炎发生率的关系.结果 发生放射性肺炎29例,放射性肺炎的发生率与照射野、照射剂量和使用化疗药物的时间有关(P<0.05),与化疗药物种类和肺部基础病变也有一定关系.结论 照射野和剂量的增加、放疗前化疗及肺部基础病变均会增加放射性肺炎的发生率. 相似文献
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乳腺癌术后放疗晚期放射性肺损伤的临床分析 总被引:1,自引:1,他引:0
目的:了解乳腺癌根治性手术后放射治疗患者晚期放射性肺损伤的发病情况并探讨其影响因素.方法:分析74例根治/改良根治术后放疗的乳腺癌患者的临床资料,其放疗后随访时间为12~84个月(中位数33.6个月).采用LENT-SOMA标准,从主观症状和客观体征(X线胸片)两方面研究晚期放射性肺损伤的发生情况,并采用Logistic回归分析其相关的发病因素.结果:晚期放射性肺损伤在主观症状和客观体征方面的发生率分别为16.2%和37.8%.多因素分析表明:患者年龄(>47岁≤)、吸烟史(有和无)、接受化疗周期数(3~6周期和>6周期)晚期放射性肺损伤的发生率分别为23.3%和47.7%(P=0.034)、0和41.2%(P=0.046)、31.0%和62.5%(P=0.022).结论:晚期放射性肺损伤是乳腺癌术后放疗患者较常见的并发症之一,有一些临床因素会增加该病的发生率. 相似文献
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[目的]分析肺癌患者放射治疗后急性放射性肺损伤发生的影响因素。[方法]选取171例肺癌放射治疗的患者,采用Logistic回归分析研究性别、年龄、是否化疗、放疗剂量、V5、V20、平均肺剂量(MLD)等因素与患者3级及以上急性放射性肺损伤发生率的相关性。[结果]171例肺癌放射治疗的患者中,发生3级及以上急性放射性肺损伤50例(29.3%)。单因素分析发现,吸烟、放疗前化疗周期数多、同期放化疗、V5>40%、V20>25%、V20>28%、MLD>10Gy、MLD>13Gy均可导致肺癌患者3级及以上放射性肺损伤发生率的升高。多因素分析显示,吸烟、放疗前化疗周期数多、V20>28%、MLD>13Gy与3级及以上放射性肺损伤发生率有关。[结论]在肺癌放疗计划设计中,应针对中国肺癌患者的特点,设定适合的物理参数;此外,还需考虑患者的吸烟史、化疗史等个体化因素,尽可能降低急性放射性肺损伤的发生率。 相似文献
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放射性肺损伤(Radiation-induced Lung Injury,RILI)是胸部肿瘤放射治疗的主要副反应之一,也是限制放射治疗剂量提升的主要原因之一。由于RILI发生机制目前尚未完全阐明,因此对其发生风险难以准确预测;同时RILI的发生具有滞后性,对于严重的RILI至今仍无有效的治疗手段,因此预测和预防显得尤为重要。尽管如此,仍有大量的研究揭示RILI的发生与患者或治疗相关的生物、物理、临床等众多因素有关。探究和寻找理想的预测因子或方法,可能降低和避免RILI的发生,对患者生存获益和生活质量的提高具有重要的意义。本文就RILI预测研究相关文献进行复习并结合我们的研究工作做一简要综述。 相似文献
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乳腺癌术后,若腋窝淋巴结超过4个或若原发灶分期为T4,需要胸壁放疗,常用5—7MeV的电子线照射,当放射线穿过皮肤时,则造成一定的损伤,引起放射性皮炎。我院自2003年6月至2005年6月收治乳腺癌术后放疗患者80例,取得较好治疗效果。现将护理体会介绍如下。 相似文献
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《Journal of thoracic oncology》2007,2(9):864-874
Radiation-induced lung injury (RILI) is the most common, dose-limiting complication of thoracic radio- and radiochemotherapy. Unfortunately, predicting which patients will suffer from this complication is extremely difficult. Ideally, individual phenotype- and genotype-based risk profiles should be able to identify patients who are resistant to RILI and who could benefit from dose escalation in chemoradiotherapy. This could result in better local control and overall survival. We review the risk predictors that are currently in clinical use—dosimetric parameters of radiotherapy such as normal tissue complication probability, mean lung dose, V20 and V30—as well as biomarkers that might individualize risk profiles. These biomarkers comprise a variety of proinflammatory and profibrotic cytokines and molecules including transforming growth factor β1 that are implicated in development and persistence of RILI. Dosimetric parameters of radiotherapy show a low negative predictive value of 60% to 80%. Depending on the studied molecule, negative predictive value of biomarkers is approximately 50%. The predictive power of biomarkers might be increased if they are coupled with radiogenomics, e.g., genotyping analysis of single nucleotide polymorphisms in transforming growth factor β1, transforming growth factor β1 pathway genes, and other cytokines. Genetic variability and the complexity of RILI and its underlying molecular mechanisms make identification of biological risk predictors challenging. Further investigations are needed to develop more effective risk predictors of RILI. 相似文献
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Haeyoung Kim Hoonsik Bae Me-Yeon Lee Kwang-Ho Cheong Kyoung Ju Kim Taejin Han Sei-Kwon Kang Soah Park Taejin Hwang Jai-Woong Yoon Lee Su Kim 《JOURNAL OF BREAST CANCER》2014,17(1):69-75
Purpose
This study was performed to assess frequency, timings of occurrence, and predictors of radiologic lung damage (RLD) after forward-planned intensity-modulated radiotherapy (FIMRT) for whole breast irradiation.Methods
We retrospectively reviewed medical records of 157 breast cancer patients and each of their serial chest computed tomography (CT) taken 4, 10, 16, and 22 months after completion of breast radiotherapy (RT). FIMRT was administered to whole breast only (n=152), or whole breast and supraclavicular regions (n=5). Dosimetric parameters, such as mean lung dose and lung volume receiving more than 10 to 50 Gy (V10-V50), and clinical parameters were analyzed in relation to radiologic lung damage.Results
In total, 104 patients (66.2%) developed RLD after whole breast FIMRT. Among the cases of RLD, 84.7% were detected at 4 months, and 15.3% at 10 months after completion of RT. More patients of 47 or younger were found to have RLD at 10 months after RT than patients older than the age (11.7% vs. 2.9%, p=0.01). In univariate and multivariate analyses, age >47 and V40 >7.2% were significant predictors for higher risk of RLD.Conclusion
RLD were not infrequently detected in follow-up CT after whole breast FIMRT. More detected cases of RLD among younger patients are believed to have developed at later points after RT than those of older patients. Age and V40 were significant predictors for RLD after whole breast intensity-modulated radiotherapy. 相似文献15.
鼻咽癌放射治疗后脑损伤49例临床分析 总被引:2,自引:0,他引:2
目的:分析鼻咽癌放射性脑损伤的临床特点及预后因素.方法:回顾性分析1998年1月至2006年6月我院收治的49例鼻咽癌放射性脑损伤患者的临床资料.结果:鼻咽癌单程放疗及再程放疗放射性脑损伤的发生率分别为2.31%(30/1 298),9.64%(19/197)(P<0.05).单程放疗及再程放疗放射性脑损伤的中位潜伏期分别为50.5个月与25.5个月(P<0.05).颞叶型、脑干型及混合型放射性脑损伤所占的比例分别为75.5%(37/49)、18.4%(9/49)、6.1%(3/49).经积极对症治疗后,放射性脑损伤的症状及体征有所改善,但生活质量明显下降.结论:鼻咽癌放射性脑损伤与射野的设计相关.放射性脑损伤以颞叶型发生率较高,再程放疗放射性脑损伤的发病率最高,且潜伏期明显缩短. 相似文献
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目的:比较容积旋转调强治疗( VMAT)和固定野调强治疗( IMRT)两种技术在乳腺癌根治术后放疗中剂量学的差异。方法:选择10例右侧根治术后乳腺癌放疗的病人,使用Oncentra4.3计划系统,快速容积旋转调强(VMAT)起始角度为55°,结束角度为215°,双弧;固定野调强技术(IMRT)采用六野照射,同一病人两种计划的中心点和优化目标条件均一样。靶区处方为50Gy/25次。评估两种计划靶区的适形度指数和均匀性指数,以及正常器官如患侧肺,正常肺,对侧乳腺,心脏等器官的剂量;机器跳数,治疗时间。结果: VMAT组的靶区均匀性指数(HI)好于IMRT(低29.9%),分别为0.129±0.021,0.184±0.04,P=0.000。适形度指数CI差别不大,差异没有统计学意义。 VMAT组的患侧肺,正常肺的V5,V20,以及平均剂量均低于IMRT组。且前者靶区内外的剂量曲线更为接近,低剂量区域的受照面积较IMRT更少,出射总跳数减少了28.5%( P=0.000),治疗时间缩短了80%(P=0.000)。结论:VMAT技术在术后乳腺癌的治疗应用上,相比IMRT技术而言,能够明显降低患侧肺及其他危及器官的受量。同时照射时间,跳数总数也明显低于IMRT,缩短了病人的治疗时间,减小了因时间过长病人移动带来的误差,降低了加速器的损耗率,提高了机器工作效率。 相似文献
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