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目的探讨不同定义的肺剂量体积直方图(DVH)参数与非小细胞肺癌(NSCLC)放射性肺炎(RP)的相关性。方法入组三维适形调强放射治疗的NSCLC患者67例。在三维放疗计划系统中勾画每一位患者的双侧肺(BV)、患侧肺(IV)、健侧肺(CV)和功能肺(FV),分别作为计划评估的独立危及器官。依据DVH曲线,回顾性分析BV、IV、CV和FV接受5～60Gy的相对肺体积(记为Vx,x=5,10,15…60)与≥2级RP(CTCAE3.0)的相关性。结果 BV5～30、IV5～15、CV5～20和FV5～20在RP组和No-RP组之间有统计学差异(P<0.05),单因素分析上述参数均与RP的发生风险相关(P<0.05),且各参数间存在显著共线性。受试者工作特征曲线证实BV5～25、IV5～15、CV5～20和FV5～20能够预测RP的发生风险,其曲线下面积范围相应分别为0.70～0.84、0.74～0.77、0.70～0.81和0.74～0.82。结论不同定义的肺DVH曲线前半部分参数均与≥2级RP的发生风险相关,各参数预测RP的ROC曲线下面积相近,约0.7～0.8。
Objective To investigate the relationship between different definitions of dose-volume histogram (DVH) parameters and non-small cell lung cancer (NSCLC) radiation pneumonitis (RP). Methods Sixty-seven NSCLC patients were enrolled in the three-dimensional conformal IMRT. Bilateral (BV), ipsilateral (IV), contralateral (CV), and functional lung (FV) profiles for each patient were plotted in a three-dimensional radiotherapy planning system as separate, endangered organs evaluated as planned. According to the DVH curve, the correlation between BV, IV, CV, and FV in subjects receiving ≥ 60 Gy of relative lung volume (denoted as Vx, x = 5, 10, 15 ... 60) and ≥2 RP (CTCAE3.0) was retrospectively analyzed . Results The BV5 ~ 30, IV5 ~ 15, CV5 ~ 20 and FV5 ~ 20 were significantly different between RP group and No-RP group (P <0.05). The univariate analysis showed that the above parameters were all related to the risk of RP <0.05), and there is significant collinearity among the parameters. The receiver operating characteristic curve confirmed that BV5 ~ 25, IV5 ~ 15, CV5 ~ 20 and FV5 ~ 20 can predict the risk of RP, the area under the curve were 0.70 ~ 0.84,0.74 ~ 0.77,0.70 ~ 0.81 and 0.74 ~ 0.82. Conclusion Different definitions of the first half of DVH curve of lung parameters are associated with the risk of ≥ 2 RP. The RPOCR of each parameter is approximately 0.7 ~ 0.8.