非小细胞肺癌调强放疗后急性放射性肺炎发生与剂量体积直方图参数之间的关系

摘要

目的：观察非小细胞肺癌（NSCLC）调强放疗后急性放射性肺炎的发生情况，探讨放射性肺炎与剂量体积直方图（DVH）参数之间的关系。方法：采用治疗计划系统对46例 NSCLC患者实施调强放疗。观察DVH参数中分别接受5、10、20及30 Gy照射的肺体积占全肺体积百分比（V5、V10、V20及V30）和全肺平均照射剂量（MLD），并对肺受照体积与急性放射性肺炎的关系进行分析。结果：NSCLC患者急性放射性肺炎的发生率为37.0％（17/46），其中0级（无放射性肺炎组）29例（63.0％），1级12例（26.1％），2级5例（10.9％），无3、4和5级放射性肺炎发生，肺 V5、V10、V20、V30和 MLD分别为53.34％、43.12％、24.15％、15.36％和16.02 Gy。放射性肺炎组患者 V5、V10、V20、V30和 MLD 分别为57.81％、48.91％、31.34％、17.83％和21.71 Gy，无放射性肺炎组患者分别为49.81％、39.78％、21.82％、13.12％和13.71 Gy，2组间比较差异有统计学意义（P＜0.05）。结论：采用调强放疗治疗 NSCLC可以较好地保护肺组织，且 DVH 中 V5、V10、V20、V30和 MLD等参数能预测放射性肺炎的发生情况。%Objective To observe the incidence of acute radiation pneumonitis (RP)after intensity modulated radiation therapy,and to explore the relationship between the incidence of RP and the parameters from dose-volume histogram (DVH)in the patients with non-small cell lung cancer (NSCLC).Methods By Pinnacle 7.6c TPS, 46 patients with NSCLC were treated by IMRT.The values of the percentages of the lung volumes receieved 5, 10,20,and 30 Gy radition to the total lung volumes (V5 ,V10 ,V20 ,V30 )and mean lung dose (MLD)were observed,and its correlation with acute RP was analyzed.Results The incidence of acute RP of the patients with NSCLC was 37.0% (17/46),among then there were 29 cases (63.0%)of Grade 0 (non-pneumonitis group), 12 cases (26.1%)of Grade 1,5 cases (10.9%)of Grade 2,and there were no Grade 4 and 5 RP.The values of V5,V10,V20,V30,and MLD of lung were 53.34 %,43.12%,24.15%,15.36 %,and 16.02 Gy.The values of V5,V10,V20,V30,and MLD in pneumonitis group were 57.81%,48.91%,31.34%,17.83%, 21.71 Gy,and they were 49. 81%,39.78%,21.82%,13.12%,and 13.71 Gy in non-pneumonitis group, there were significant differences between two groups (P<0.05).Conclusion The intensity modulated radiation therapy in treatment of NSCLC can protect the lung tissue,and the parameters of DVH such as V5 ,V10 ,V20 , V30 and MLD can predict the occurrence of RP.