本文關(guān)鍵詞： 淋巴瘤 放射性肺損傷 預測模型　出處：《北京協(xié)和醫(yī)學院》2017年博士論文　論文類型：學位論文

【摘要】：研究背景:淋巴瘤是常見的血液系統(tǒng)腫瘤,而放療在淋巴瘤的治療中具有重要地位。在接受膈上放療的淋巴瘤患者中,放射性肺損傷是胸部主要的劑量限制因素之一。目前淋巴瘤患者的肺部限量主要參考肺癌的標準,但考慮到淋巴瘤患者與肺癌患者的臨床和治療差異,肺部限量或許應有其獨特性。研究目的:分析淋巴瘤調(diào)強放療后放射性肺損傷的影響因素,探索各劑量-體積直方圖(dose-volume histogram,DVH)參數(shù)與放射性肺損傷的關(guān)系,建立預測模型觀察DVH參數(shù)與放射性肺損傷發(fā)生概率的相關(guān)趨勢,尋找淋巴瘤患者肺部劑量限制的臨界點。材料與方法:回顧性分析309例調(diào)強放療淋巴瘤患者,其中196例有完整的DVH參數(shù)信息�；羝娼鹆馨土龊头腔羝娼鹆馨土龌颊邤�(shù)分別為151和158例,83.5%的非霍奇金淋巴瘤患者為彌漫大B細胞淋巴瘤。所有患者均采用化療后受累野放療的綜合治療方案,5例患者接受了自體干細胞移植。研究的終點事件為所有等級放射性肺損傷和癥狀性放射性肺損傷,嚴重程度的評估采用CTCAE 4.0版(肺炎)。建立平滑風險比模型、Lyman-Kutcher-Burman模型(LKB模型)和多因素回歸模型觀察肺平均劑量(mean lung dose,MLD)和Vx(受照射劑量大于等于x Gy的正常肺組織體積百分比)與放射性肺損傷發(fā)生概率的關(guān)系,通過ROC曲線尋找潛在限量分界點,通過ROC曲線下面積比較各模型的預測能力。結(jié)果:放射性肺損傷的發(fā)病率為34.3%,癥狀性放射性肺損傷為3.6%。對所有等級放射性肺損傷的單因素分析顯示,ECOG評分≥2分、乳酸脫氫酶升高、放療后化療和所有DVH參數(shù)是癥狀性放射性肺損傷的危險因素,但乳酸脫氫酶升高在多因素分析中喪失了顯著性。療前B癥狀和V15-V40為癥狀性放射性肺損傷的危險因素。在目前的淋巴瘤的處方劑量下,MLD和V5-V40與所有等級放射性肺損傷近乎呈線性關(guān)系,未發(fā)現(xiàn)潛在劑量限制臨界點。而對癥狀性放射性肺損傷而言,低劑量區(qū)(V5-V15)與癥狀性放射性肺損傷相關(guān)性差,中等劑量區(qū)存在癥狀性放射性肺損傷的限量臨界點(MLD15.1 Gy‘V2028%、V2520%和V3015%),高劑量區(qū)(V30-V40)與癥狀性放射性肺損傷呈線性相關(guān)。AUC比較顯示,對所有等級癥狀性放射性肺損傷而言,DVH參數(shù)的平滑風險比模型、LKB模型和多因素邏輯回歸模型的預測能力無統(tǒng)計學差異。但對癥狀性放射性肺損傷而言,中-高劑量區(qū)的影響更顯著,低劑量區(qū)的貢獻相對較小。結(jié)論:要最大程度的降低所有等級放射性肺損傷需根據(jù)最佳DVH參數(shù)組合最大程度降低肺部受量,但如果只以減少癥狀為目的,應優(yōu)先限制中高劑量區(qū)的限量問題。
[Abstract]:Background: lymphoma is a common hematologic tumor, and radiotherapy plays an important role in the treatment of lymphoma. Radiation lung injury is one of the main dose limiting factors in the chest. At present, the lung limit of lymphoma patients mainly refers to the standard of lung cancer, but considering the difference of clinical and treatment between lymphoma patients and lung cancer patients. Lung limitation may have to be unique. Objective: to analyze the risk factors of radiation induced lung injury after intensity-modulated radiotherapy for lymphoma. Objective: to explore the relationship between dose-volume histogrammetric volume (DVH) parameters and radiation lung injury. A predictive model was established to observe the correlation between DVH parameters and the probability of radiation-induced lung injury. Materials and methods: 309 patients with IMRT were analyzed retrospectively. Among them, 196 cases had complete DVH parameter information. The number of patients with Hodgkin's lymphoma and non-Hodgkin 's lymphoma were 151 and 158, respectively. 83.5% of patients with non-Hodgkin 's lymphoma were diffuse large B-cell lymphoma. All patients were treated with a combination of post-chemotherapeutic field radiotherapy. Five patients received autologous stem cell transplantation. The endpoint of the study was all grade radiation lung injury and symptomatic radiation lung injury. The severity was assessed using CTCAE version 4.0 (pneumonia). A smooth risk ratio model was established. Lyman-Kutcher-Burman model (LKB model) and multivariate regression model were used to observe mean lung dose. The relationship between MLDs and VX (volume percentage of normal lung tissue with irradiation dose greater than x Gy) and the probability of radiation induced lung injury was found by ROC curve. The predictive ability of each model was compared by the area under the ROC curve. Results: the incidence of radiation lung injury was 34.3%. Symptomatic radiation-induced lung injury was 3.6%. Univariate analysis of all grade radiation-induced lung injury showed that ECOG score 鈮，

本文編號：1459812