肺癌患者三维适形放疗前后肺功能的动态变化及与放射性肺炎发生的关系研究

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及其与放射性肺炎发生率的关系。方法68例未手术的肺癌患者，男42例，女26例，中位年龄52岁，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（CLCO），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，无V级病例。FVC放疗前与放疗后3个月0级（n=44）和I＋Ⅱ＋Ⅲ＋Ⅳ级（n：24）放射性肺炎者比较，差异无统计学意义（P〉0．05），而FEVl．0和DLCO放疗前与放疗后3个月的0级（n=44）和I＋Ⅱ＋Ⅲ级＋Ⅳ级（n=24）放射性肺炎者比较，差异有统计学意义（P〈0．05）。V20，V30及MLD平均值越大，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FEVl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 three-dimensional conformal radiation therapy in patients with non-small cell lung cancer

Objective To explore the relationships among pulmonary function,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 inoperable patients (male 42,female 26,median age 52,KPS≥80) before and after three months radiotherapy respectively.After 3 months of follow-up,radiation pneumonitis were graded,and V20,V30 and MLD were derived from dose volume histogram (DVH).Results All patients were treated with radiotherapy at the irradiation dose of 60～70Gy.Acute radiation pneumonitis occurred in 24 patients with 11 Grade Ⅰ,7 Grade Ⅱ,3 Grade Ⅲ,3 Grade Ⅳ.There were no significant difference between the pre-irradiation and the three months after irradiation for FVC (P＞0.05).But there were significant different between pre-irradiation and three months after irradiation for FEV1.0 and DLCO (P＜0.05).V20,V30 and MLD were observed in patients treated with high radiation pneumonitis.Conclusions There were close relationships among pulmonary function,DVH and radiation pneumonitis in patients with non-small cell lung cancer.