Dose-volume histogram analysis as predictor of radiation pneumonitis in primary lung cancer patients treated with radiotherapy

PURPOSE: To determine the relationship between various parameters derived from lung dose-volume histogram analysis and the risk of symptomatic radiation pneumonitis (RP) in patients undergoing radical radiotherapy for primary lung cancer. METHODS AND MATERIALS: The records of 156 patients with lung cancer who had been treated with radical radiotherapy (>/=45 Gy) and for whom dose-volume histogram data were available were reviewed. The incidence of symptomatic RP was correlated with a variety of parameters derived from the dose-volume histogram data, including the volume of lung receiving 10 Gy (V(10)) through 50 Gy (V(50)) and the mean lung dose (MLD). RESULTS: The rate of RP at 6 months was 15% (95% confidence interval 9-22%). On univariate analysis, only V(30) (p = 0.036) and MLD (p = 0.043) were statistically significantly related to RP. V(30) correlated highly positively with MLD (r = 0.96, p < 0.001). CONCLUSION: V(30) and MLD can be used to predict the risk of RP in lung cancer patients undergoing radical radiotherapy.     

Initial evaluation of treatment-related pneumonitis in advanced-stage non-small-cell lung cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy

PURPOSE: To investigate the rate of high-grade treatment-related pneumonitis (TRP) in patients with advanced non-small-cell lung cancer (NSCLC) treated with concurrent chemotherapy and intensity-modulated radiotherapy (IMRT). METHODS AND MATERIALS: From August 2002 to August 2005, 151 NSCLC patients were treated with IMRT. We excluded patients who did not receive concurrent chemotherapy or who had early-stage cancers, a history of major lung surgery, prior chest RT, a dose <50 Gy, or IMRT combined with three-dimensional conformal RT (3D-CRT). Toxicities were graded by Common Terminology Criteria for Adverse Events version 3.0. Grade > or = 3 TRP for 68 eligible IMRT patients was compared with TRP among 222 similar patients treated with 3D-CRT. RESULTS: The median follow-up durations for the IMRT and 3D-CRT patients were 8 months (range, 0-27 months) and 9 months (range, 0-56 months), respectively. The median IMRT and 3D-CRT doses were 63 Gy. The median gross tumor volume was 194 mL (range, 21-911 mL) for IMRT, compared with 142 mL (range, 1.5-1,186 mL) for 3D-CRT (p = 0.002). Despite the IMRT group's larger gross tumor volume, the rate of Grade > or = 3 TRP at 12 months was 8% (95% confidence interval 4%-19%), compared with 32% (95% confidence interval 26%-40%) for 3D-CRT (p = 0.002). CONCLUSIONS: In advanced NSCLC patients treated with chemoradiation, IMRT resulted in significantly lower levels of Grade > or = 3 TRP compared with 3D-CRT. Clinical, dosimetric, and patient selection factors that may have influenced rates of TRP require continuing investigation. A randomized trial comparing IMRT with 3D-CRT has been initiated.     

非小细胞肺癌三维适形放疗剂量体积直方图参数与放射性肺损伤CT分级的关系

目的 探讨剂量体积直方图(DVH)参数与非小细胞肺癌(NSCLC)三维适形放疗(3D-CRT)后放射性肺损伤CT分级的关系.方法 将3D-CRT治疗后CT随访6个月以上的169例Ⅰ～Ⅲ期NSCLC患者,按随访CT放射性肺损伤的表现分级(0～4级),并分为CT阳性组(2～4级)和CT阴性组(0～1级).从放疗计划中获取患者的DVH参数,分析DVH参数与放射性肺损伤CT分级的关系,评价DVH参数对放射性肺损伤的预测价值.结果 不同CT分级的全肺及患侧肺正常组织并发症概率(NTCP)值差异有统计学意义,随着CT分级的增加,NTCP相应增大.不同CT分级的全肺及患侧肺平均肺受照剂量(MLD)差异有统计学意义,随着CT分级的增加,全肺及患侧肺MLD相应增大.不同CT分级的全肺及患侧肺V20、V30和V40差异均有统计学意义,随着CT分级的增加,全肺及患侧肺V20、V30、V40相应增大.不同CT分级患者健侧肺的DVH参数差异无统计学意义.全肺、患侧肺DVH参数与患侧肺CT分级联系紧密,其中患侧肺NTCP与CT分级关联度最强(η=0.522).结论 NTCP、MID、V20、V30、V40等DVH参数与NSCLC 3D-CRT后放射性肺损伤的CT分级密切相关,可以作为评价及优化放疗计划的指标,以减少放疗后放射性肺损伤的发生.     

Genetic variants of the LIN28B gene predict severe radiation pneumonitis in patients with non-small cell lung cancer treated with definitive radiation therapy

BackgroundLIN28 is an RNA-binding protein that not only plays key roles in multiple cellular developmental processes and tumourigenesis, but also is involved in tissue inflammatory response. However, no published study has investigated associations between genetic variants in LIN28 and radiation-induced pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC) treated with definitive radiation therapy.MethodsWe genotyped eight potentially functional single nucleotide polymorphisms (SNPs) of LIN28A (rs11247946 T>C, rs3811464 C>T, rs11581746 T>C, and rs12728900 G>A) and LIN28B (rs314280 G>A, rs12194974 G>A, rs17065417 A>C and rs314276 C>A) in 362 patients with NSCLC, who received definitive radio(chemo)therapy. The associations between RP risk and genotypes were assessed by hazards ratio (HR) in Cox proportional hazards regression analysis with time to event considered with and without adjustment for potential confounders.ResultsMultivariate analyses found that patients carrying LIN28B rs314280 AG and AA/AG or rs314276 AC and AA/AC genotypes had a higher risk of grade ⩾3 RP (for rs314280 AG and AA/AG versus GG, adjusted HR = 2.97 and 2.23, 95% confidence interval (CI) = 1.32–6.72 and 1.01–4.94, P = 0.009 and 0.048, respectively; for rs314276 AC and AA/AC versus CC, adjusted HR = 2.30 and 2.00, 95% CI = 1.24–4.28 and 1.11–3.62, and P = 0.008 and 0.022, respectively). Further stratified analyses showed a more consistent and profound risk in the subgroups of age <65 years, males, stage III/IV, ever smokers, having radio-chemotherapy and mean lung dose (MLD) ⩾19.0 Gy.ConclusionGenetic variants of LIN28B, but not LIN28A, may be biomarkers for susceptibility to severe RP in NSCLC patients. Large, prospective studies are needed to confirm our findings.     

Analysis of dose-volume histogram parameters for radiation pneumonitis after definitive concurrent chemoradiotherapy for esophageal cancer

Purpose

To evaluate dose-volume histogram (DVH) parameters as predictors of radiation pneumonitis (RP) in esophageal cancer patients treated with definitive concurrent chemoradiotherapy.

Patients and methods

Thirty-seven esophageal cancer patients treated with radiotherapy with concomitant chemotherapy consisting of 5-fluorouracil and cisplatin were reviewed. Radiotherapy was delivered at 2 Gy per fraction to a total of 60 Gy. For most of the patients, two weeks of interruption was scheduled after 30 Gy. The percentage of lung volume receiving more than 5-50 Gy in increments of 5 Gy (V5-V50, respectively), and the mean lung dose (MLD) were analyzed.

Results

Ten (27%) patients developed RP of grade 2; 2 (5%), grade 3; 0 (0%), grade 4; and 1 (3%), grade 5. By univariate analysis, all DVH parameters (i.e., V5-V50 and MLD) were significantly associated with grade ?2 RP (p < 0.01). The incidences of grade ?2 RP were 13%, 33%, and 78% in patients with V20s of ?24%, 25-36%, and ?37%, respectively. The optimal V20 threshold to predict symptomatic RP was 30.5% according to the receiver operating characteristics curve analysis.

Conclusion

DVH parameters were predictors of symptomatic RP and should be considered in the evaluation of treatment planning for esophageal cancer.     

Genetic variants of the nonhomologous end joining gene LIG4 and severe radiation pneumonitis in nonsmall cell lung cancer patients treated with definitive radiotherapy

BACKGROUND:

Nonhomologous end joining (NHEJ) is a pathway that repairs DNA double‐strand breaks (DSBs) to maintain genomic stability in response to irradiation. The authors hypothesized that single nucleotide polymorphisms (SNPs) in NHEJ repair genes may affect clinical outcomes in patients with nonsmall cell lung cancer (NSCLC) who receive definitive radio(chemo)therapy.

METHODS:

The authors genotyped 5 potentially functional SNPs—x‐ray repair complementing defective repair in Chinese hamster cells 4 (XRCC4) reference SNP (rs) number rs6869366 (?1394 guanine to thymine [?1394G→T] change) and rs28360071 (intron 3, deletion/insertion), XRCC5 rs3835 (guanine to adenine [G→A] change at nucleotide 2408), XRCC6 rs2267437 (?1310 cytosine to guanine [C→G) change], and DNA ligase IV (LIG4) rs1805388 (threonine‐to‐isoleucine change at codon 9 [T9I])—and estimated their associations with severe radiation pneumonitis (RP) (grade ≥3) in 195 patients with NSCLC.

RESULTS:

A predictive role in radiation pneumonitis (RP) development was observed for the LIG4 SNP rs1805388 (adjusted hazard ratio, 2.08; 95% confidence interval, 1.04‐4.12; P = .037 for the CT/TT genotype vs the CC genotype). In addition, men with the TT genotype of the XRCC4 rs6869366 SNP and women with AG + AA genotypes of the XRCC5 rs3835 SNP also were at increased risk of developing severe RP.

CONCLUSIONS:

The current results indicated that NHEJ genetic polymorphisms, particularly LIG4 rs1805388, may modulate the risk of RP in patients with NSCLC who receive definitive radio(chemo)therapy. Large studies will be needed to confirm these findings. Cancer 2011;. © 2011 American Cancer Society.     

肺癌同步放化疗中紫杉醇剂量递增临床Ⅰ和Ⅱ期试验

目的评价诱导化疗后小剂量紫杉醇同时合并放疗不能手术非小细胞肺癌的毒性和疗效。方法对25例病理确诊的不能手术非小细胞肺癌患者首先接受诺维本 顺铂方案诱导化疗2～3个周期，1个月后接受同步放化疗。三维适形放疗总剂量60Gy，30分次，6～7周完成。紫杉醇剂量递增试验每次15mg/m^2，共分5个组：2次／周2周组、2次／周4周组、2次／周6周组、3次／周4周组、3次／周6周组，每组3例。3次／周6周组增加9例，以验证其重复性。采用美国RTOG制定的放射反应评价标准评价副反应。若每组3例中1例出现3级以上副反应则在同一剂量水平重复试验。终止试验的标准是3级以上副反应发生率≥2／6或剂量达到常规化疗剂量135mg/m^2。结果除1例因紫杉醇过敏反应外，24例均按计划完成了治疗，各剂量组至少已递增1次。3次／周4周组治疗期间3例中1例出现3级疲劳，增加3例重复该剂量，未再发生3级以上副反应。放化疗期间发生1、2级放射性食管炎14例，其中需要软食、流质者2例；1、2级放射性肺炎7例，其中需要激素治疗的2级3例。24例疗后评价完全缓解2例，部分缓解17例，病情稳定3例，进展的2例分别转移至肝脏、腹膜后淋巴结。结论诱导化疗后每次15mg/m^2、3次／周6周的紫杉醇合并放疗不能手术非小细胞肺癌是安全有效的。     

Comparison of risk and predictors for early radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with radiotherapy with or without surgery

ObjectivesTo investigate risk and predictors for radiation pneumonitis (RP) and tolerance of lung to radiation in patients treated with thoracic radiotherapy (RT) with or without surgery.Methods and materialsA total of 433 consecutive patients with locally advanced non-small cell lung cancer were followed after three-dimensional conformal radiotherapy. Among them 284 received RT without surgical intervention and 149 received postoperative radiotherapy (PORT). RP was graded according to Common Terminology Criteria for Adverse Events version 4.0.ResultsThe rate of grade ≥2 and grade ≥3 RP was 50 and 16% in the PORT group compared with 38 and 9% in the non-surgical group (p < 0.05 for each comparison). The lung volume was significantly smaller in PORT group than in no-surgical group (3181 ± 915 cm³ vs. 4010 ± 1120 cm³, p < 0.05). Age, chemotherapy, mean lung dose (MLD) and planning target volume (PTV) were predictors of RP for both non-surgical group and PORT group. Mean heart dose (MHD) predicted RP in PORT group only (OR = 1.28, p = 0.003). Among patients who developed RP, V20, MLD, and MHD were significantly lower in PORT group than in no-surgical group (p < 0.05 for each comparison).ConclusionsExcept MHD predicting RP in PORT group only, most of predictors for RP were consistent in patients treated with RT with or without surgery. Patients receiving PORT had a higher risk of RP than patients receiving RT without surgery did, possibly due to decreased lung volume and lower tolerance of lung to chemoradiotherapy.     

三维适形放射治疗高龄肺癌30例临床分析

目的 探讨三维适形放射治疗(three-dimensional conformal radiotherapy，3D-CRT)治疗Ⅰ～Ⅲ期高龄非小细胞肺癌的疗效及副作用。方法 对30例行3D-CRT治疗的Ⅰ～Ⅲ期高龄非小细胞肺癌进行回顾性分析。30例患者共设46个靶区。靶区剂量归一到等中心处，分割剂量3～5Gy，总量42～66Gy，3～5次／周，周剂量≤15Gy。结果 总1、2、3年生存率及中位生存期分别为65．8％、41、2％、20、6％、23个月。肿瘤1、2、3年局部控制率分别59．8％、31．1％、28．3％。放射性肺炎发生率为16．7％(5／30)，其中≥3级放射性肺炎发生率为6．7％(2／30)，1例因放射性肺炎而死亡。放射性肺纤维化发生率为10、0％(3／30)，均为1～2级。放射性食管炎的发生率分别为43．3％(13／30)．均为1～2级。结论 利用3D-CRT治疗提高肿瘤剂量，从而提高高龄肺癌的生存率，并发症低，是治疗高龄肺癌的较好手段。     

Radiation pneumonitis following concurrent accelerated hyperfractionated radiotherapy and chemotherapy for limited-stage small-cell lung cancer: Dose-volume histogram analysis and comparison with conventional chemoradiation

PURPOSE: The aim of this study was twofold: to determine whether the dose-volume metrics are valuable in predicting radiation pneumonitis (RP) in small-cell lung cancer (SCLC) patients treated with accelerated hyperfractionated radiotherapy and chemotherapy (AHFRT + CT); and to clarify how AHFRT influences the risk of RP in comparison to conventional once-daily radiotherapy and chemotherapy (QDRT + CT). METHODS AND MATERIALS: Study subjects were 43 patients with SCLC treated with AHFRT + CT. Radiotherapy was delivered at 1.5 Gy/fraction (fr) twice daily to 45 Gy/30 fr/3 weeks. We analyzed the relation between RP incidence and several dosimetric factors. We also compared this series data with our previously published data from lung cancer patients treated with QDRT + CT. RESULTS: Radiation pneumonitis Grades 1, 2, and 3 were observed in 28 patients, 7 patients, and 1 patient, respectively. Univariate analysis revealed that the percentage of lung volume receiving more than 15 Gy, 20 Gy, and 30 Gy (V15, V20, V30) and normal tissue complication probability were of predictive value for the development of RP. The 12-month cumulative incidences of RP greater than Grade 2 were 0%, 7.1%, 25%, and 42.9% in patients with a V20 of < or =20%, 21-25%, 26-30%, and > or =31%, respectively. These incidences were lower than that of our patients treated with QDRT + CT. CONCLUSIONS: Dosimetric factors are valuable in predicting RP in SCLC patients treated with AHFRT + CT. Regarding the incidence of RP, AHFRT appears to have some advantage over QDRT.     

三维适形放疗局部晚期非小细胞肺癌的放射性肺炎风险因素研究

目的分析三维适形放疗(3DCRT)的ⅢA和ⅢB期非小细胞肺癌病例,分别评估≥2、3级放射性肺炎的发生与临床及剂量学参数的关系。方法107例病理组织学证实的ⅢA、ⅢB期非小细胞肺癌接受了平均60(26-74)Gy的3DCRT,其中42例单纯放疗,65例序贯放化疗。记录各临床因素及剂量体积直方图(DVH)参数,观察放疗结束3个月内发生的≥2级放射性肺炎(RP)和≥3级的放射性肺炎(SRP)。分级采用NCICTC3.0标准,统计用SPSS10.0软件包。结果107例共发生放射性肺炎39例,其中2级26例,3级10例,5级3例,SRP标准的13例。对RP单因素分析显示MLD、IMLD、CMLD、IV20-IV35、CV10、CV15、CV40、CV50及V10-V35有统计学意义(P=0.004、0.009、0.047、0.010、0.008、0.014、0.031、0.022、0.016、0.023、0.026、0.048、0.006、0.002、0.027、0.032、0.043),多因素分析显示V20是惟一RP发生的预测因子(P=0.005)。对SRP单因素分析显示MLD、IV20、IV25、IV30、CV5、CV10、V10、V15、V20、V30有统计学意义(P=0.005),多因素分析显示CV10是惟一SRP发生的预测因子(P=0.028)。结论对Ⅲ期非小细胞肺癌3DCRT,DVH参数与放射性肺炎的发生明显相关,其中V20、CV10分别是预测RP、SRP的剂量学指标。     

MVP化疗同步结合放疗治疗晚期非小细胞肺癌的临床疗效

目的　评价MVP(丝裂霉素、长春地辛和顺铂 )方案化疗同步结合放疗治疗晚期非小细胞肺癌的临床疗效。方法　 62例由细胞学或病理证实、初治、KPS评分 60分以上、预计生存时间 3个月以上的ⅢB期或Ⅳ期非小细胞肺癌患者 ,采用信封抽签法分为放化疗组和MVP组各 3 1例。两组患者都接受MVP化疗 ,丝裂霉素 6mg/m2 静脉注射 ,第 1天 ;长春地辛 2mg/m2 静脉注射 ,第 1、8天 ;顺铂 80～ 10 0mg/m2 静脉滴注。每三周重复。放化疗组放射治疗与化疗同时进行 ,照射剂量为 46～ 5 6Gy/5～ 6周。 结果　两组患者接受化疗 2～ 4个周期。放化疗组和MVP组有效率分别为 48.4% (15 /3 1)和 19.4% (6/3 1) (P <0 .0 5 ) ,中位肿瘤进展时间分别为 8个月和 4个月 (P <0 .0 5 ) ,中位生存时间分别为 10个月和 6个月 (P <0 .0 5 ) ,1年生存率分别为 5 4.8% (17/3 1)和 2 2 .6% (7/3 1) (P <0 .0 5 )。放化疗组的骨髓毒性重于MVP组 ,有显著性差异 (P<0 .0 5 ) ;胃肠道反应等两组无显著性差异 (P >0 .0 5 )。结论　MVP化疗同步结合放疗治疗晚期非小细胞肺癌 ,较单纯化疗更能有效地控制肿瘤进展、延长患者的生存时间 ,毒副作用可以耐受。     

310例65岁以上老年人非小细胞肺癌的手术治疗

背景与目的：随着医疗健康条件的改善,人类预期寿命不断延长。2012年,全世界60岁以上的人口已达到8.1亿,占全世界总人口的11％。全球人口老龄化的进程将不可避免地导致越来越多的老年人被诊断出肺癌,对这类人群的手术方式仍然存在争议。本文通过研究老年肺癌的临床特点,了解不同手术方式对老年人肺癌预后的影响。方法：2006—2012年,共有310例年龄在65岁以上的非小细胞肺癌(non-small cell lung cancer,NSCLC)患者于中国医科大学附属第一医院胸外科及吉林省肿瘤医院胸部肿瘤外二科接受手术治疗。我们对患者的性别、疾病分期、组织学、吸烟状况、吸烟量、手术方法、多学科综合治疗和总生存期等临床资料进行回顾性分析。生存分析采用Kaplan-Meier法和log-rank检验。结果：256例(82.6％)老年患者接受标准的肺叶切除术,54例(17.4％)患者接受姑息切除术。总体的5年生存率为52.9％。接受不同手术方式(肺叶切除术和姑息切除术)的患者5年生存率相似(60.5％ vs 60.8％,P=0.381)。性别(P=0.024)、疾病分期(P=0.028)、吸烟状态(P=0.034)和吸烟量(P=0.028)显著地影响了患者的预后。多变量Cox比例风险分析显示,吸烟状况是影响肺癌患者预后的独立因素,相关的风险比为1.660(1.058~2.606,P=0.028)。结论：在老年NSCLC患者中,与肺叶切除术相比,姑息切除同样可延长患者的生存期。吸烟状况与老年肺癌患者的生存期密切相关。     

改善肿瘤细胞乏氧状态对非小细胞肺癌放疗效果的影响

 目的 为了观察改善肿瘤细胞的乏氧状态对非小细胞肺癌（NSCLC）放疗效果的影响。方法 随机选择Ⅱ~Ⅳ期的NSCLC患者42例，资料完整者38例，在放射治疗前30 min内，采用舒氧康静脉内给氧的方法，提高血液中的氧分压，改善肿瘤细胞的乏氧状态；给氧前、后分别作血气分析，然后及时给予放射治疗，每次2 Gy，每日1次，每周5 d，总剂量60 ~ 70 Gy，随机选取同期的常规普放NSCLC患者37例作对照，按WHO疗效评价标准评价疗效，并作统计学处理。结果 试验组内给氧前后的动脉氧分压（PO2）分别为（85.6±7.5）mmHg，（103±9.7）mmHg；内给氧前后的血氧饱和度（SaO2）分别为（89.5±6.1）%和（94.4±5.2）%；放疗有效率为63.16 %（24／38）。对照组的有效率为43.24 %（16／37），试验组的疗效优于对照组（0.05＜P＜0.1），而两组之间毒副反应的发生率差异无统计学意义（P）。结论 放疗前静脉内给氧可改善肿瘤细胞的乏氧状态，提高放射治疗效果。     

经调强适形放疗治疗的肺癌患者发生放射性肺炎的相关因素分析

 目的　探讨调强适形放疗（IMRT）治疗肺癌发生放射性肺炎（RP）的相关因素,寻找合理的预测性指标,为放疗计划的制定提供参考。方法　对163例经IMRT治疗肺癌患者的临床资料及剂量-体积直方图的相关参数进行量化分析,放疗结束后随访时间≥6个月,应用统计学方法研究其与RP之间的关系。结果　≥2级RP的发生率为28.22 %（46／163）。单因素分析发现下叶肿瘤（P＝0.033）、合并慢性阻塞性肺疾病（COPD）（P＝0.020）、联合化疗（P＝0.020）、未预防性使用糖皮质激素及抗生素（P＝0.025）与RP的发生有关。其中肺基础疾病及联合化疗是影响≥2级RP发生的独立因素。多因素分析表明健侧肺V20、全肺V5及靶区总体积是RP发生的独立影响因素。结论　RP的发生与多种因素相关,放疗计划应根据患者的具体情况合理地制定。     

非小细胞肺癌抗血管生成治疗研究现状

血管生成是指从已有血管网络中生成新生血管的生理过程.在肿瘤微环境中,一个不断增长的肿瘤的动态平衡有利于转向持续促血管生成状态.自人类认识到可以通过抵抗肿瘤血管生成从而抑制肿瘤生长后,抗血管生成药物应运而生并已被应用在多种实体肿瘤中,包括肺癌.本文就肿瘤血管生成以及非小细胞肺癌抗血管生成的研究现状进行综述.     

ＣＴ／ＣＴ图像融合用于非小细胞肺癌放射治疗对Ｖ２０及放射性肺炎影响的临床研究

目的　探讨ＣＴ／ＣＴ图像融合技术应用于非小细胞肺癌（ＮＳＣＬＣ）放射治疗计划对Ｖ２０和放射性肺炎（ＲＰ）的影响。方法　４０例入组患者均经病理组织学或细胞学证实为ⅢＡ、ⅢＢ期ＮＳＣＬＣ,三维适形放疗（３Ｄ-ＣＲＴ）剂量达到４０００ｃＧｙ肿块缩小达２５％后随机分为常规缩野放疗组２０例（Ａ组）和ＣＴ／ＣＴ图像融合缩野放疗组２０例（Ｂ组）,两组均追加剂量至６６００ｃＧｙ。记录临床资料、Ｖ２０、放疗结束３个月内ＲＰ发生情况等。ＲＰ用ＲＴＯＧ急性放射性损伤分级标准判断。采用ＳＰＳＳ１１.５软件包进行统计学分析。结果　４０例患者中ＲＰ发生率为２２.５％（９／４０）,其中Ａ组６例（３０.０％）,Ｂ组３例（１５.０％）,两组间差异无统计学意义（Ｐ＝０.２5６）。Ａ、Ｂ组的患侧肺Ｖ２０（ＩＶ２０）和全组的健侧肺Ｖ２０（ＣＶ２０）、患侧肺Ｖ２０均与ＲＰ发生有关,差异有统计学意义（Ｐ＜０.０５）,Ｗｉｌｃｏｘｏｎ检验两组间患侧肺Ｖ２０、健侧肺Ｖ２０差异均有统计学意义（Ｐ＜０.０５）。结论　ＣＴ／ＣＴ图像融合执行的缩野追加剂量放疗未增加ＲＰ的发生率,且有可能降低患侧肺Ｖ２０,为进一步提高局部放疗剂量,获得更好的局控率提供了理论参考依据。     

三维适形加量放射治疗非小细胞肺癌

目的：探讨三维适形加量放射治疗非小细胞肺癌（NSCLC）的优势。方法：21例非小细胞肺癌,CT模拟机定位,输入TPS（Pinnacle^3 7．4／7．6）,勾画GTV1,先常规或三维适形放疗30Gy／15F～50Gy／25F,第2次CT定位,勾画GTV2,予三维适形放射治疗至66Gy／33F～70Gy／35F。结果：GTV2与GTVl相比,平均缩小比例39．5％,13例大于40％。近期疗效：CR19．0％,PR71．4％,NC9．5％,总有效率（CR＋PR）90．5％,1年生存率85．7％。早期放射性肺损伤：1级13例（61．9％）,2级6例（28．6％）,3级2例（9．5％）。放射性食管炎：1级15例（71．4％）,2级6例（28．6％）。后期放射肺纤维化：0级2例（9．5％）,1级15例（71．4％）,2级4例（19．0％）。结论：三维适形加量放射治疗NSCLC过程中,肿瘤平均退缩比例为39．5％,再次重新勾画GTV并加量,可以有效地减少治疗范围,提高靶区剂量,降低放射治疗副反应。