食管癌患者三维适形放射治疗后放射性肺损伤与肺低剂量区受照体积的关系

目的分析食管癌患者三维适应放射治疗后放射性肺损伤与肺低剂量区受照体积的关系。方法回顾性选取我院2015年1月~2020年1月诊断的96例食管癌患者作为研究对象，所有患者均采取三维适应放射进行治疗，依据美国肿瘤放射治疗协作组织的诊断标准，比较放射性肺损伤以及非放射性肺损伤患者的一般资料、V5、V10、V20、V30、平均肺剂量、最小肺剂量、最大肺剂量之间的差异，研究造成放射性肺损伤与肺低剂量区受照体积的相关性。结果放射性肺损伤以及非放射性肺损伤患者的性别、年龄、BMI、TNM分期、病理类型之间的差异无统计学意义（P > 0.05）；发生放射性肺损伤V5（P < 0.001）、V10（P < 0.001）、V20（P < 0.001）、V30（P < 0.001）、平均肺剂量（P < 0.001）高于非放射性肺损伤患者，两组患者的最小肺剂量、最大肺剂量之间的差异无统计学意义（P > 0.05）；通过肺损伤严重程度肺剂量的回归分析，在对患者的治疗中，V5、V10、V20是造成患者唯一2级以上放射性肺损伤的高危因素，而患者的放射性肺纤维化与肺剂量之间不存在相关性。结论V5、V10、V20是对放射性肺炎的有效预测因素，所以在对患者的治疗中，在对治疗效果进行保证的前提下，可通过肺低剂量区受照体积进行调整，及时降低放射性肺损伤的产生，对于患者的预后具有积极的意义。 

Relationship between radiation-induced lung injury after three dimensional adaptive radiology and lung low-dose exposure volume in patients with esophageal cancer

ObjectiveTo explore the relationship between radiation-induced lung injury after three dimensional adaptive radiology and lung low-dose volume in patients with esophageal cancer.MethodsIn this retrospective study, 96 patients with esophageal cancer diagnosed in our hospital from January 2015 to January 2020 were selected. All patients were treated with Three dimensional adaptive radiology. According to the diagnostic criteria of the American cancer radiotherapy collaboration, the general information, V5, V10, V20, V30, average lung dose and minimum lung dose of patients with radiation-induced lung injury and non radiation-induced lung injury were compared to analyze the correlation between radiation-induced lung injury and the exposure volume in low dose area.ResultsThere was no significant difference in gender, age, body mass index, TNM stage and pathological type between radiation-induced and non radiation-induced lung injury patients (P > 0.05). V5 (P < 0.001), V10 (P < 0.001), V20 (P < 0.001), V30 (P < 0.001) and average lung dose (P < 0.001) of radiation-induced lung injury patients occurred. There was no significant difference in the minimum lung dose and maximum lung dose between the two groups(P > 0.05). Through the regression analysis of lung dose of lung injury severity, in the treatment of patients, V5, V10 and V20 were the only high-risk factors of radiation-induced lung injury above grade 2, while the patients were more likely to suffer from radiation-induced lung injury. There was no correlation between lung dose and radiation-induced pulmonary fibrosis(P > 0.05).ConclusionV5, V10, V20 are effective predictors of radiation pneumonitis. In the treatment of patients, we can adjust the radiation volume of low-dose area of lung to reduce the occurrence of radiation-induced lung injury in time with the premise of ensuring the treatment effect. It has positive significance for the prognosis of patients.