肺癌患者急性放射性肺损伤发生的相关因素分析

目的]分析肺癌患者放射治疗后急性放射性肺损伤发生的影响因素。方法]选取171例肺癌放射治疗的患者,采用Logistic回归分析研究性别、年龄、是否化疗、放疗剂量、V5、V20、平均肺剂量(MLD)等因素与患者3级及以上急性放射性肺损伤发生率的相关性。结果]171例肺癌放射治疗的患者中,发生3级及以上急性放射性肺损伤50例(29.3%)。单因素分析发现,吸烟、放疗前化疗周期数多、同期放化疗、V5>40%、V20>25%、V20>28%、MLD>10Gy、MLD>13Gy均可导致肺癌患者3级及以上放射性肺损伤发生率的升高。多因素分析显示,吸烟、放疗前化疗周期数多、V20>28%、MLD>13Gy与3级及以上放射性肺损伤发生率有关。结论]在肺癌放疗计划设计中,应针对中国肺癌患者的特点,设定适合的物理参数;此外,还需考虑患者的吸烟史、化疗史等个体化因素,尽可能降低急性放射性肺损伤的发生率。

An Analysis of Related Factors to Acute Radiation Pneumonitis in Patients with Lung Cancer

Purpose] To investigate the related factors to acute radiation pneumonitis in patients with lung cancer after radiotherapy.Methods] One hundred and seventy one patients with lung cancer after radiotherapy were enrolled.Logistic regression was applied to analyze the relationship between incidence of acute radiation pneumonitis over grade 3 and factors including gender,age,chemotherapy,radiation dose,V5,V20 and mean lung dose（MLD）.Results] Of 171 patients,50 patients（29.3%） occurred acute radiation pneumonitis over grade 3.The univariate analysis showed that patient with smoking,excessive chemotherapy cycles before radiotherapy,concurrent chemoradiotherapy,V540%,V2025%,V2028%,MLD10Gy and MLD13Gy all had a higher incidence rate of acute radiation pneumonitis over grade 3.The multivariate analysis showed that smoking,excessive chemotherapy cycles before radiotherapy,V2028% and MLD13Gy increased the incidence rate of acute radiation pneumonitis over grade 3.Conclusion] For lung cancer radiotherapy plan designing,not only the suitable physical parameters,but also patient＇s individual factors including smoking history,chemotherapy history should be considered in order to decrease incidence rate of acute radiation pneumonitis.