Exceptionally high incidence of symptomatic grade 2-5 radiation pneumonitis after stereotactic radiation therapy for lung tumors.
Exceptionally high incidence of symptomatic grade 2-5 radiation pneumonitis after stereotactic radiation therapy for lung tumors.
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DOI：
10.1186/1748-717x-2-21
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发表时间：
2007-06-07
期刊：
影响因子：
--
通讯作者：
Ohtomo K
中科院分区：
文献类型：
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作者：
Yamashita H;Nakagawa K;Nakamura N;Koyanagi H;Tago M;Igaki H;Shiraishi K;Sasano N;Ohtomo K
为了确定剂量体积直方图（DVH）因子预测立体定向放射治疗（SRT）治疗肺肿瘤后放射性肺炎（RP）发生的有效性，在照射前测量DVH因子。从2004年5月至2006年4月，25例患者在东京大学医院接受了SRT治疗。18例患者患有原发性肺癌，7例患有转移性肺癌。SRT采用直线加速器，等中心剂量48戈伊，分4次照射6-7个野，5-8天。根据NCI-CTC第3.0版，2-5例患者中有7例患有症状性2-5级RP。在完成SRT后18个月，RP 2级或以上的总体发生率为29%，3例患者死于RP。RP发生在具有较高一致性指数（CI）的患者中的频率显著增加（p = 0.0394）。平均肺剂量（MLD）显示与V5-V20（照射肺体积）显著相关（p < 0.001），但与CI无相关性。RP与MLD无统计学相关性。MLD与V5的相关性最强。即使在SRT中，当大体积的肺实质被照射到计划靶体积内的最小剂量这样高的剂量时，肺毒性的发生率也会变高。
To determine the usefulness of dose volume histogram (DVH) factors for predicting the occurrence of radiation pneumonitis (RP) after application of stereotactic radiation therapy (SRT) for lung tumors, DVH factors were measured before irradiation. From May 2004 to April 2006, 25 patients were treated with SRT at the University of Tokyo Hospital. Eighteen patients had primary lung cancer and seven had metastatic lung cancer. SRT was given in 6–7 fields with an isocenter dose of 48 Gy in four fractions over 5–8 days by linear accelerator. Seven of the 25 patients suffered from RP of symptomatic grade 2–5 according to the NCI-CTC version 3.0. The overall incidence rate of RP grade2 or more was 29% at 18 months after completing SRT and three patients died from RP. RP occurred at significantly increased frequencies in patients with higher conformity index (CI) (p = 0.0394). Mean lung dose (MLD) showed a significant correlation with V5–V20 (irradiated lung volume) (p < 0.001) but showed no correlation with CI. RP did not statistically correlate with MLD. MLD had the strongest correlation with V5. Even in SRT, when large volumes of lung parenchyma are irradiated to such high doses as the minimum dose within planning target volume, the incidence of lung toxicity can become high.