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目的探讨剂量体积参数与放疗后肺功能变化关系,并预测肺癌患者放疗后的肺功能。方法39例未手术肺癌患者在放疗前1周、放疗后2～4个月分别进行肺功能检测。观测肺功能指标:FVC、FEV 1.0、DLCO。剂量体积参数包括肺V_(10)、V_(15)、V_(20)、V_(25)、V_(30)、V_(35)、V_(40)、D_(mean)、V_(eff)、NTCP、CTV_(100)、CTV_(95)、CTV_(90)、CTV_(80)、照射野数及GTV大小。采用Pearson相关和线性回归方法分析两者之间关系。结果放疗后各肺功能指标变化与对应的剂量体积参数间未见明显的相关性。除外放疗前合并肺不张者(15例)后,肺功能指标的变化与肺V_(20)、V_(25)、V_(30)、V_(35)、V_(40)、GTV、D_(mean)、V_(eff)存在明显相关(r =0.469～0.695,P≤0.05)。多因素回归分析显示肺V_(30)是影响FEV 1.0、DLCO减低的剂量体积因素(P=0.046、0.041),且V_(30)≥18%的患者肺功能受损明显高于V_(30)<18%者。结论放疗不伴肺不张的肺癌患者时,肺V_(30)能够预测放疗后肺功能变化。
Objective To investigate the relationship between dose volume parameters and changes of lung function after radiotherapy and to predict lung function after radiotherapy in patients with lung cancer. Methods Thirty-nine patients with non-surgical lung cancer underwent lung function tests one week before radiotherapy and two to four months after radiotherapy. Observation of lung function indicators: FVC, FEV 1.0, DLCO. The dose volume parameters include the lung V 10, V 15, V 20, V 25, V 30, V 35, V 40, D mean, V eff, NTCP, CTV_ (100), CTV_ (95), CTV_ (90), CTV_ (80), irradiation field and GTV size. Pearson correlation and linear regression analysis of the relationship between the two. Results After radiotherapy, there was no significant correlation between changes of lung function indexes and corresponding dose volume parameters. Except for the patients with atelectasis (15 cases) before radiotherapy, the changes of pulmonary function indexes were related with the changes of V_ (20), V_ (25), V_ (30), V_ (35), V_ (40), GTV, D_ mean and V eff were significantly correlated (r = 0.469 ~ 0.695, P≤0.05). Multivariate regression analysis showed that lung V_ (30) was a dose-volume factor (P = 0.046, 0.041) that decreased FEV 1.0 and DLCO, and was significantly higher than V_ (30) in patients with V_ (30) <18%. Conclusions Lung V_ (30) can predict the change of pulmonary function after radiotherapy in patients with lung cancer without radiotherapy without atelectasis.