- 期刊
- OpenAccess
Clinical Risk Factors of Radiation Pneumonitis after 3D Conformal Radiotherapy for Lung Cancer
肺癌病患接受三度空間順形放療後發生放射性肺炎之臨床危險因子
摘要
放射治療為肺癌治療方式之一，而放射性肺炎為其重要併發症之一。本文報告肺癌病患接受三度空間順形放療之臨床經驗，特別注重於放射性肺炎臨床危險因子之探討。 自2003年4月至2004年3月就肺癌病患接受三度空間順形放療並有完整肺部劑量及至少3個月追蹤者進行回顧性分析。放射性肺炎之分級係依共通毒性標準第三版，並以單變數分析方式分析放射性肺炎之臨床危險因子。 本研究共包含35位病人。多數為第三期非小細胞肺癌(54%,19/35)並接受同步化放療(51%,18/35)。中位放療劑量為54格雷，中位V20為22.7%，中位平均肺部劑量(MLD)為14.3格雷。經中位追蹤6個月，有三位病人發生第二級放射性肺炎。就病患、腫瘤、治療、放療各相關臨床因子進行分析，發現MLD（至少16格雷）為重要之危險因子（發生率3/12比0/23，p值為0.03）。V20（至少25%）與原發腫瘤部位（中下肺葉）亦可能為危險因子（p值為0.056）。 MLD、V20及原發腫瘤部位可能可以預測肺癌病患接受三度空間順形放療發生放射性肺炎之可能性。仍需更多研究以了解放射性肺炎之其他可能危險因子。
並列摘要
Radiotherapy (RT) was an important tool in treating lung cancer. Radiation pneumonitits (RP) was one of the major side effects after thoracic RT. RP may further offset the potential survival benefit of concurrent chemoradiotherapy (CCRT). We reported our clinical results of 3D conformal radiotherapy (3DCRT) with focus on risk factors of RP. From Apr 2003 to Mar 2004, medical records of consecutive patients with lung cancer receiving thoracic RT with detailed lung dose data (V20 and mean lung dose (MLD)) and at least 3 months’ follow up (FU) were reviewed and constituted the study group. Common toxicity criteria III were used for grading of RP. Univariate analysis by Fisher’s exact test was used for analysis of risk factors. Thirty-five patients fulfilled our criteria. Most of them had stage III non-small cell lung cancer (NSCLC) (19/35) and received CCRT (18/35). The median RT dose was 54Gy. The median V20 and MLD were 22.7% and 14.3Gy. Grade II RP was noted in three patients only after median follow up of 6 months. Among patient, tumor, treatment, and RT related factors, MED (≧l6Gy) was found to be a significant risk factor (risk: 3/12 vs 0/23, p =0.03). V20(≧25%) and tumor location (middle/lower lobes) were also found to be risk factors with borderline statistical significance (p=0.056) MED, V20 and the location of primary tumor were possible clinical predictors of radiation pneumonitis after 3D conformal radiotherapy for lung cancer. Further work up was needed to clarify other possible risk factors.
延伸閱讀
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