放疗前肺功能参数对非小细胞肺癌放射性肺炎的预测价值

目的 观察肺癌患者三维适形放疗后放射性肺炎的发生情况,探讨放疗前肺功能参数在预测非小细胞肺癌放射性肺炎方面的价值.方法 对81例接受三维适形放射治疗并符合入组条件的非小细胞肺癌患者进行放疗前基础肺功能测定,并记录剂量体积参数,观察放疗后放射性肺炎的发生情况,对患者临床资料、肺功能参数、剂量体积参数等指标进行单因素及多因素分析,评价肺功能参数预测放射性肺炎的价值.结果 全组患者中17例出现≥2级放射性肺炎,占21.0%(17/81),其中2级15例,3级2例,无4、5级放射性肺炎发生.单因素分析结果显示,放疗前肺功能指标FEV1.0、FEV1.0/FVC、DLCO及放疗计划指标PTV体积、双肺MLD、V5、V20、V30,均影响患者≥2级放射性肺炎的发生(P<0.05).≥2级放射性肺炎组患者肺功能参数FEV1.0、FEV1.0/FVC、DLCO指标值均低于0、1级放射性肺炎组,且有统计学意义(P<0.05).多因素分析结果显示:FEV1.0、FEV1.0/FVC、DLCO等相关肺功能指标值并非≥2级放射性肺炎的独立影响因素,仅双侧肺脏MLD、V5、V20及V30为患者≥2级放射性肺炎发生的独立影响因素(P<0.05).结论 基础肺功能参数FEV1.0、FEV1.0/FVC、DLCO在≥2级急性放射性肺炎预测方面具有一定价值,肺功能受损是放射性肺炎的高危因素,但并非影响放射性肺炎的独立因素.

Predictive Value of Lung Function Parameters on Radiation Pneumonitis in Patients with Non-small-cell Lung Cancer

Objective To observe the incidence of radiation pneumonitis in non-small cell lung cancer (NSCLC) treated with 3D-CRT radiation therapy ,and investigate the relation between basic lung function and radiation pneumonitis .Methods 81 patients with NSCLC treated with radiotherapy were followed up .The basic lung function and treatment parameters were analyzed by univariate and multivariate analysis .Indexes of basic lung function were evaluated .Results The radiation pneumonitis ≥grade 2 were observed in 17 patients(21.0%,17/81).The incidence of grade 2,3 and 4 were 15/81,2/81 and 0/81,respective-ly.Univariate analysis showed that the FEV1.0,FEV1.0/FVC,DLCO,PTV volume and lung MLD,V5-V30 all had significant re-lationship with ≥grade 2 radiation pneumonitis .Multivariate analysis showed that MLD and Lung V 5-V30 were the independent risk factors for ≥grade 2 RP,FEV1.0,FEV1.0/FVC,DLCO were not the independent risk factors for ≥grade 2 radiation pneu-monitis .Conclusion Lung function parameters can predict the incidence of≥2 grade radiation pneumonitis to some extent ,espe-cially when the value of FEV1.0,FEV1.0/FVC,and DLCO is lower.However,impaired lung function is not the independent risk factors for ≥grade 2 radiation pneumonitis .