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。

Analysis on the influential factors of radiation pneumonitis after intensity modulated radiotherapy in lung cancer patients

Objective　To identify the factors related to radiation pneumonia (PR) in lung cancer treated with intensity modulated radiotherapy(IMRT). Methods　Data from 163 lung cancer patients treated with IMRT were analyzed with clinical factors and physical parameters related to the dose-volume histogram. The patients were followed for 6 months after radiotherapy. The relationship between survival status and PR was analyzed. Results　The incidence rate of over grade 2 patients was 28.22 % (46/163). Univariate analysis revealed a significant relationship between many parameters associated with such as the site of lobe (P = 0.033), COPD (P = 0.020), chemotherapy (P = 0.020) and prophylactic using of glucocorticoid and antibiotic (P = 0.025). Multilogistic regression analysis showed that V20 in the contralateral site, the V5 of the all lungs and PTVV were independent factors. Conclusion　The RP is associated with multiple factors. Individualized treatment plans should be made according to the specific circumstances of patients.