Analysis of risk factors for radiation pneumonitis in elderly patients with lung cancer after stereotactic radiotherapy
Objective To analyze the incidence and risk factors of symptomatic radiation pneumonitis(SRP)in elderly patients with lung cancer after stereotactic radiotherapy.Methods A retrospective analysis was conducted on the clinical and radiotherapy data of 150 elderly patients with non-small cell lung cancer(NSCLC)treated by stereotactic radiotherapy in Hua-dong Hospital Affiliated to Fudan University from October 2014 to June 2023.They were divided into SRP group and non-SRP group according to whether they had SRP or not.The bioequivalent dose-volume parameters of normal lung tissue(VBED10,20,30 200),V5,V20,mean lung dose(MLD),gross tumor volume(GTV),planned target volume(PTV)and clinical parameters were compared between the two groups.Logistic regression analysis was used to identify risk factors for SRP in elderly lung cancer patients.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of related factors to the occurrence of SRP.A bioequivalent dose-volume histogram(BEDVH)of normal lung tissue was drawn.Results The incidence of SRP was 16％(24/150).Univariate analysis showed that there were statistically differences in tumor diameter,PTV,radiotherapy frequency,MLD,V5,V20 and VBED10-200 between the non-SRP group and the SRP group(P＜0.05).Multivariate regression analysis showed that VBED70 was an independent risk factor for SRP(OR=5.59,P＜0.001),with an area under the curve(AUC)of 0.918,sensitivity of 0.85,and specificity of 0.92,which was superior to V5 and V20(AUC values of 0.754,0.895,respectively).The optimal cut-off value for VBED70 was 2.45％,and there was a statistically significant difference in the cumulative incidence of SRP among different VBED70 groups(Log rank P＜0.001).Conclusion For elderly lung cancer patients receiving stereotactic radiotherapy with various fractionation schemes in the real world,the use of unified lung bioequivalent dose-volume parameters may better predict the risk of SRP than physical dose parameters.
万方数据
维普
