Physical and biological predictors of changes in whole-lung function following thoracic irradiation
Physical and biological predictors of changes in whole-lung function following thoracic irradiation
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DOI：
10.1016/s0360-3016(97)00343-x
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发表时间：
1997-10-01
影响因子：
7
通讯作者：
Anscher, M
中科院分区：
文献类型：
--
作者：
Marks, LB;Munley, MT;Anscher, M
目的：通过前瞻性研究胸部放疗（RT）后肺功能的变化，建立预测RT后肺后果的方法。方法和材料：100例胸部或邻近肿瘤治疗期间接受偶然部分肺放疗的患者，通过症状和肺功能检查评估全肺功能（PFT：FEV 1-用力呼气量1 s;所有受试者均接受基于计算机断层扫描的三维（3D）剂量计算，并对剂量-体积直方图（DVH）进行肺密度异质性校正和正常组织并发症概率（NTCP）计算。分别在50名和48名患者中获得了基于SPECT（单光子发射计算机断层扫描）肺灌注扫描和系列转化生长因子-β（TGF-β（1））水平的功能性DVH（DVfH）。全肺功能变化的发生率和严重程度与临床、身体和生物学因素相关。探索性统计分析采用卡方，皮尔逊相关性，逻辑回归，多元线性regression.Results：RT诱导的症状在21例患者。在整个组中，症状发展的单一最佳预测因子是NTCP（p < 0.05）。单独的RT前PFT预测性较低（FEV 1 p = 0.1，DLCO p = 0.08）。基于RT前DLCO和基于CT的NTCP的多变量模型强烈预测症状的发展（p < 0.001）。基于SPECT衍生的DVfH和TGF-β（1）水平的NTCP似乎没有提供额外的预测价值。肺部症状的存在或不存在与RT后6个月PFT的下降相关（p < 0.05）。在整个组中，PFT的下降程度与所考虑的任何剂量-体积变量均不相关。在RT前PFT“良好”的患者中，PFT减少百分比与剂量-体积参数之间存在相关性，例如接受> 30戈伊的肺体积百分比（p < 0.05）。结论：全肺功能改变（症状或PFT变化）的程度似乎与剂量-体积和RT前PFT参数相关。这些数据表明，没有一个变量可能是一个足够的预测和多变量预测模型将需要。正在进行更多的研究，以开发更好的预测模型，考虑物理因素，如DVH和局部灌注，以及生物学/临床因素，如RT前PFT和TGF-β（1）。(C)1997年爱思唯尔科学公司
Purpose: To develop methods of predicting the pulmonary consequences of thoracic irradiation (RT) by prospectively studying changes in pulmonary function following RT.Methods and Materials: 100 patients receiving incidental partial-lung irradiation during treatment of tumors in or adjacent to the thorax had whole-lung function assessed via symptoms and pulmonary function tests (PFTs: FEV1-forced expiratory volume 1 s; DLCO-diffusion capacity) before and repeatedly 6-48 months following RT. All had computed tomography-based three-dimensional (3D) dose calculations with lung density heterogeneity corrections for dose-volume histogram (DVH) and normal tissue complication probability (NTCP) calculations. Functional DVHs (DVfH) based on SPECT (single photon emission computed tomography) lung perfusion scans, and serial transforming growth factor-beta (TGF-beta(1)) levels were available in 50 and 48 patients, respectively. The incidence and severity of changes in whole-lung function were correlated with clinical, physical, and biological factors. Exploratory statistical analyses were performed using chi-square, Pearson correlations, logistic regression, and multiple linear regression.Results: RT-induced symptoms developed in 21 patients. In the overall group, the single best predictor for the development of symptoms was the NTCP (p < 0.05). Pre-RT PFTs alone were less predictive (p = 0.1 for FEV1, p = 0.08 for DLCO). A multivariate model based on pre-RT DLCO and CT-based NTCP was strongly predictive for the development of symptoms (p < 0.001). NTCPs based on SPECT-derived DVfHs and TGF-beta(1) levels did not appear to provide additional predictive value. The presence or absence of pulmonary symptoms was correlated with the decline in PFT 6 months following RT (p < 0.05). In the overall group, the degree of decline in PFTs was not well correlated with any of the dose-volume variables considered. In patients with ''good'' pre-RT PFTs, there was a relationship between the percent reduction in PFT and dose-volume parameters such as the percent of lung volume receiving > 30 Gy (p < 0.05).Conclusion: The extent of alteration in whole-lung function (symptoms or PFT changes) appears to be related to both dose-volume and pre-RT PFT parameters. The data suggest that no one variable is likely to be an adequate predictor and that multivariate predictive models will be needed. Additional studies are underway to develop better predictive models that consider physical factors such as the DVH and regional perfusion, as well as biologican/clinical factors such as pre-RT PFTs and TGF-beta(1). (C) 1997 Elsevier Science Inc.