肺癌患者放疗前后肺功能的动态变化

目的探讨非小细胞肺癌三维适形放疗前后肺功能的动态变化。方法 68例未手术的肺癌患者,KPS评分≥80分,均行三维适形放疗,放疗前及放疗后1、3个月检查肺功能主要参数用力肺活量(FVC)、1s用力呼气量(FEV1)、肺一氧化碳弥散量(DLCO),同时观察放射性肺炎的发生率及程度。结果所有患者均完成放疗,剂量为60～70Gy。24例患者发生不同程度放射性肺炎,其中Ⅰ级11例,Ⅱ级7例,Ⅲ级3例,Ⅳ级3例。FVC在放疗前和放疗后3个月0级(44例)和Ⅰ+Ⅱ+Ⅲ+Ⅳ级(24例)放射性肺炎患者差异无统计学意义(P>0.05),而FEV1和DLCO在放疗前和放疗后3个月的0级(44例)和Ⅰ+Ⅱ+Ⅲ级+Ⅳ级(24例)放射性肺炎患者差异有统计学意义(P<0.05)。V20,V30及平均肺密度(MLD)值越大,放射性肺炎程度越高。结论非小细胞肺癌放疗后DLCO水平显著降低,放射性肺炎患者FEV1和DLCO放疗后显著降低。V20,V30及MLD可预测放射性肺炎发生。

A clinical observation of pulmonary function changes following radiation therapy in patients with non-small cell lung cancer

Objective To explore the relationships among pulmonary function,dose volume histogram(DVH) and acute radiation pneumonitis after three-dimensional conformal radiation treatment in patients with non-small-cell lung cancer.Methods Pulmonary function tests were conducted on 68 unoperable patients,KPS≥80,before and after three months radiotherapy,respectively.After the 3 months of follow-up,radiation pneumonitis were graded and V20,V30 and MLD were derived from DVH.Results All patients were treated radiotherapy with irradiation dose of 60~70 Gy,acute radiation pneumonitis occurred in 24 patients with 11 Grade Ⅰ,7 Grade Ⅱ,3 Grade Ⅲ,3 Grade Ⅳ,and no GradeⅤ pneumonitis appeared.There were no significant difference between the pre-irradiation and the three months after irradiation for FVC(P>0.05).But there was significant difference between pre-irradiation and three months after irradiation for FEV1 and DLCO(P<0.05).V20,V30 and MLD were observed in patient treated with higher radiation pneumonitis.Conclusion There is a close relationship among pulmonary function,DVH and radiation pneumonitis in patients with non-small cell lung cancer.