摘要
目的对非小细胞肺癌(NSCLC)吉西他滨化疗后急性放射性肺炎(ARP)的发生情况进行总结,阐明吉西他滨诱导化疗后发生急性放射性肺炎的高危因素及剂量学限制。方法回顾性分析2010-2017年间浙江省肿瘤医院放疗科收治的接受吉西他滨化疗+胸部放疗的NSCLC患者191例,收集患者的基本信息、放化疗情况以及ARP情况。Logistic法单因素和多因素分析影响ARP发生的因素。结果共49例患者发生≥2级ARP,占25.7%。单因素分析显示吉西他滨累积剂量≥9.0 g发生ARP概率是<9.0 g的3.45倍(P=0.015),放疗剂量≥50 Gy与ARP发生有关(P=0.008),放化疗间隔时间在10周内ARP发生风险增加7.69倍(P=0.047);双肺V5Gy、V20Gy、V30Gy和平均肺剂量(MLD)均能有效预测ARP发生(P≤0.001)。多因素分析仅有放疗剂量(P=0.044)和V5Gy(P=0.02)是ARP发生的预测因素。结论对于接受吉西他滨化疗的NSCLC患者来说,吉西他滨累积剂量、化放疗间隔时间以及放疗剂量均与ARP的发生有关,同时应当限制双肺V5Gy、V20Gy、V30Gy和MLD,以减少ARP的发生。
Objective To summarize the incidence of acute radiation pneumonitis(ARP)after gemcitabine induction chemotherapy for non-small cell lung cancer(NSCLC)and identify the high risk factors and dosimetric limitations of ARP after gemcitabine induction chemotherapy.Methods We retrospectively analyzed 191 NSCLC cases who were received gemcitabine induction chemotherapy and chest radiotherapy in radiotherapy department of Zhejiang Cancer Hospital between January 2010 and December 2010.Base line data,treatment information and the incidence of ARP after treatment were collected.The risk factors of ARP were analyzed with univariate and multivariate Logistic regression method.Results A total of 49 patients developed≥gradeⅡARP,accounting for 25.7%of all cases.Univariate analysis indicated that the probability of ARP in patients who received the cumulative dose of gemcitabine≥9.0g was 3.45 times higher than that in those treated at a dose of<9.0g(P=0.015).Radiation dose≥50Gy was significantly correlated with the occurrence of ARP(P=0.008).The risk of ARP was increased by 7.69 times if the time interval between radiotherapy and chemotherapy was within 10 weeks(P=0.047).Among the dosimetric parameters,V5Gy,V20Gy,V30Gy and mean lung dose(MLD)of bilateral lungs were 45%,22%,16%,and 1200 cGy respectively.All of them could effectively predict the occurrence of ARP(all P≤0.001).Multivariate analysis indicated that only radiotherapy dose(P=0.044)and V5Gy(P=0.02)were the independent predictors of ARP.Conclusions For NSCLC patients who receive gemcitabine induction chemotherapy,the cumulative dose of gemcitabine,the interval time between chemotherapy and radiotherapy and the radiation dose are associated with the occurrence of ARP.We should strictly limit the total lung dosimetric parameters,such as V5Gy,V20Gy,V30Gy and MLD to reduce the incidence of ARP.
作者
崔晓颖
盛李明
杜向慧
Cui Xiaoying;Sheng Liming;Du Xianghui(The Second Clinical Medical College,Zhejiang Chinese Medical University,Hangzhou 310053,China;Department of Thoracic Radiotherapy,Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital),Institute of Cancer and Basic Medicine(IBMC),Chinese Academy of Sciences,Hangzhou 310022,China)
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2020年第7期519-522,共4页
Chinese Journal of Radiation Oncology
关键词
急性放射性肺炎
肺肿瘤/放化疗法
因素分析
Acute radiation pneumonitis
Lung neoplasm/radiochemotherapy
Factor analysis
