Can we predict radiation-induced changes in pulmonary function based on the sum of predicted regional dysfunction?
Can we predict radiation-induced changes in pulmonary function based on the sum of predicted regional dysfunction?
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DOI：
10.1200/jco.2001.19.2.543
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发表时间：
2001-01-15
影响因子：
45.3
通讯作者：
Munley, MT
中科院分区：
文献类型：
--
作者：
Fan, M;Marks, LB;Munley, MT
目的：为了确定是否在全肺肺功能测试（PFT）值的变化有关的预测放射治疗（RT）引起的变化区域肺perfusion.Patients和方法的总和：在1991年和1998年之间，96例（61%肺癌）谁是偶然接受部分肺照射进行了前瞻性研究。在至少6个月的随访期内，对患者进行RT前后PFT（一秒用力呼气量[FEV 1]和一氧化碳弥散量[DLCO]）评估，如果确定胸内复发对肺功能有影响，则排除患者。注意到PFT值的最大下降。基于RT诱导的局部灌注（功能）减少的剂量反应模型用于预测局部功能障碍。预测的肺功能下降计算为预测的局部损伤的加权和：[图形]其中V-d是照射剂量d的肺体积，R-d是剂量d时预期的局部灌注减少。结果：预测和测量的PFT值减少之间的关系对于未校正的DLCO（P =.005）是显著的，对于DLCO（P =.06）和FEV 1（P =.08）是临界显著的。然而，相关系数很小（范围为0.18至0.30）。在肺癌患者中，相关系数随着随访评估次数的增加而提高（范围为0.43 ~ 0.60），尤其是当排除中央纵隔/肺门胸部肿块附近肺灌注不足的患者时（范围为0.59 ~ 0.91）。结论：预测的RT诱导的局部灌注变化的总和与RT诱导的肺功能变化有关。然而，在许多患者中，解释的变异百分比很小，这使得准确预测变得困难。J Clin Oncol 19：543-550. (C)2001年，美国临床肿瘤学会。
Purpose: To determine whether changes in whole-lung pulmonary function test (PFT) values are related to the sum of predicted radiation therapy (RT)-induced changes in regional lung perfusion.Patients and Methods: Between 1991 and 1998, 96 patients (61% with lung cancer) who were receiving incidental partial lung irradiation were studied prospectively. The patients were assessed with pre- and post-RT PFTs (forced expiratory volume in one second [FEV1] and diffusion capacity for carbon monoxide [DLCO]) for at least a 6-month follow-up period, and patients were excluded if it was determined that intrathoracic recurrence had an impact on lung function. The maximal declines in PFT values were noted. A dose-response model based on RT-induced reduction in regional perfusion (function) was used to predict regional dysfunction. The predicted decline in pulmonary function was calculated as the weighted sum of the predicted regional injuries:[GRAPHICS]where V-d is the volume of lung irradiated to dose d,and R-d is the reduction in regional perfusion anticipated at dose d.Results: The relationship between the predicted and measured reduction in PFT values was significant for uncorrected DLCO (P =.005) and borderline significant for DLCO (P =.06) and FEV1 (P =.08). However, the correlation coefficients were small (range, .18 to .30). In patients with lung cancer, the correlation coefficients improved as the number of follow-up evaluations increased (range,.43 to .60), especially when patients with hypoperfusion in the lung adjacent to a central mediastinal/hilar thoracic mass were excluded (range, .59 to .91).Conclusion: The sum of predicted RT-induced changes in regional perfusion is related to RT-induced changes in pulmonary function. In many patients, however, the percentage of variation explained is small, which renders accurate predictions difficult. J Clin Oncol 19:543-550. (C) 2001 by American Society of Clinical Oncology.