Analysis of Clinical and Dosimetric Factors Influencing Radiation-Induced Lung Injury in Patients with Lung Cancer.
Analysis of Clinical and Dosimetric Factors Influencing Radiation-Induced Lung Injury in Patients with Lung Cancer.
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DOI：
10.7150/jca.12314
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发表时间：
2015
影响因子：
3.9
通讯作者：
Mao W
中科院分区：
文献类型：
--
作者：
Han S;Gu F;Lin G;Sun X;Wang Y;Wang Z;Lin Q;Weng D;Xu Y;Mao W
目的：胸部放疗剂量递增可以提高局部肿瘤的控制率和生存率，但同时也受到放射性肺损伤（RILI）的限制。本研究旨在探讨肺癌患者接受放化疗时影响RILI的临床和剂量学因素，以便更好地制定放射计划。方法和材料：对2010年4月至2011年5月期间接受放化疗的161例非小细胞或小细胞肺癌（分别为NSCLC和SCLC）患者进行了回顾性分析，中位随访时间为545天（范围：39-1453天）。化疗方案基于组织学类型（鳞状细胞癌、腺癌或小细胞肺癌），放疗剂量为1.8-3.0戈伊（中位数，2.0戈伊），每日一次，总计39-66戈伊（中位数，60戈伊）。进行单因素分析以分析与RILI相关的临床和剂量学因素。多因素分析采用逻辑回归确定独立的危险因素与RILI。结果：症状性RILI（≥ 2级）的发生率为31.7%。单变量分析显示V5、V20和平均肺剂量（MLD）与RILI发生率显著相关（分别为P=0.029、0.048和0.041）。组织学类型（NSCLC vs. SCLC，P = 0.092）或放射技术（IMRT vs. 3D-CRT，P = 0.095）的相关性无统计学意义。多因素分析显示MLD是症状性RILI的独立危险因素（OR=1.249，95%CI=1.055-1.48，P= 0.01）。肿瘤位于单侧的病例中双侧RILI的发生率为22.7%（32/141），除1级（低）RILI（P <0.05）外，双侧与同侧损伤的所有剂量学参数值均无显著差异（P> 0.05）。同侧肺损伤患者RILI分级高于双侧肺损伤患者（Mann-Whitney U检验，z=8.216，P< 0.001）。结论：剂量学参数MLD是RILI的独立预测因子。在常规放射治疗计划的条件下，额外的对侧损伤似乎与RILI分级增加无关。
Purpose: Dose escalation of thoracic radiation can improve the local tumor control and surivival, and is in the meantime limited by the occurrence of radiation-induced lung injury (RILI). This study investigated the clinical and dosimetric factors influencing RILI in lung-cancer patients receiving chemoradiotherapy for better radiation planning. Methods and Materials: A retrospective analysis was carried out on 161 patients with non-small-cell or small-cell lung cancer (NSCLC and SCLC, respectively), who underwent chemoradiotherapy between April 2010 and May 2011 with a median follow-up time of 545 days (range: 39-1453). Chemotherapy regimens were based on the histological type (squamous cell carcinoma, adenocarcinoma, or SCLC), and radiotherapy was delivered in 1.8-3.0 Gy (median, 2.0 Gy) fractions, once daily, to a total of 39-66 Gy (median, 60 Gy). Univariate analysis was performed to analyze clinical and dosimetric factors associated with RILI. Multivariate analysis using logistic regression identified independent risk factors correlated to RILI. Results: The incidence of symptomatic RILI (≥grade 2) was 31.7%. Univariate analysis showed that V5, V20, and mean lung dose (MLD) were significantly associated with RILI incidence (P=0.029, 0.048, and 0.041, respectively). The association was not statistically significant for histological type (NSCLC vs. SCLC, P = 0.092) or radiation technology (IMRT vs. 3D-CRT, P = 0.095). Multivariate analysis identified MLD as an independent risk factor for symptomatic RILI (OR=1.249, 95%CI=1.055-1.48, P= 0.01). The incidence of bilateral RILI in cases where the tumor was located unilaterally was 22.7% (32/141) and all dosimetric-parameter values were not significantly different (P>0.05) for bilateral versus ipsilateral injury, except grade-1 (low) RILI (P < 0.05). The RILI grade was higher in cases of ipsilateral lung injury than in bilateral cases (Mann-Whitney U test, z=8.216, P< 0.001). Conclusion: The dosimetric parameter, MLD, was found to be an independent predictive factor for RILI. Additional contralateral injury does not seem to be correlated with increased RILI grade under the condition of conventional radiotherapy treatment planning.