PURPOSE: To determine the incidence

PURPOSE: To determine the incidence of and risk factors for radiation pneumonitis (RP) after stereotactic ablative radiation therapy (SABR) to the lung in patients who had previously undergone conventional thoracic radiation therapy. METHODS AND MATERIALS: Seventy-two patients who had previously received conventionally fractionated radiation therapy to the thorax were treated with SABR (50 Gy in 4 fractions) for recurrent disease or secondary parenchymal lung cancer (T/=3) RP and potential predictive factors were analyzed by univariate and multivariate logistic regression analyses. A scoring system was established to predict the risk of RP. RESULTS: At a median follow-up time of 16 months after SABR (range, 4-56 months), 15 patients had severe RP (14 [18.9%] grade 3 and 1 [1.4%] grade 5) and 1 patient (1.4%) had a local recurrence. In univariate analyses, Eastern Cooperative Oncology Group performance status (ECOG PS) before SABR, forced expiratory volume in 1 second (FEV1), and previous planning target volume (PTV) location were associated with the incidence of severe RP. The V10 and mean lung dose (MLD) of the previous plan and the V10-V40 and MLD of the composite plan were also related to RP. Multivariate analysis revealed that ECOG PS scores of 2-3 before SABR (P=.009), FEV1/=30% of the composite plan (P=.021), and an initial PTV in the bilateral mediastinum (P=.025) were all associated with RP. CONCLUSIONS: We found that severe RP was relatively common, occurring in 20.8% of patients, and could be predicted by an ECOG PS score of 2-3, an FEV1/=30% on composite (previous RT+SABR) plans. Prospective studies are needed to validate these predictors and the scoring system on which they are based.

結果 (中文) 1:

目的︰ 确定的发生率和风险因素为放射性肺炎 (RP) 后烧蚀立体定向放射治疗 (SABR) 以前曾接受过常规胸部放射治疗的病人的肺部。方法和材料︰ 七十二岁曾收到对胸部常规分割的放射治疗患者进行 SABR (4 馏分中的 50 Gy) 为复发性疾病或次要实质肺癌 (T < 4 厘米，N0，M0 或 Mx)。严重 (等级 > / = 3) RP 和潜在的预测因素进行单因素和多因素 logistic 回归分析。建立了一个评分系统预测 RP 的风险。结果︰ 在 16 个月后 SABR （范围，4 56 个月） 随访时间中位数，15 例患者有严重 RP （14 [18.9%] 等级 3 和 1 [1.4%] 5 年级） 和 1 （1.4%) 患者的局部复发。在单变量分析中，东部合作肿瘤小组性能状态 (ECOG PS) 前 SABR，用力呼气量在 1 秒 (FEV1) 和先前计划靶体积 (PTV) 位置都与严重的 RP 的发病率相关联。V10 和肺剂量 (MLD) 及以前的计划与 V10 V40 MLD 复合计划还涉及到 RP 的意思。多变量分析表明，2-3 前 SABR ECOG PS 评分 (P =。 009)，FEV1/ = 复合计划的 30%(P =。 021)，和双边纵隔初始 PTV (P =.025) 都与 RP。结论︰ 我们发现严重 RP 是相对较常见，发生在 20.8%的患者，和可以预测的 2-3，FEV1 ECOG PS 评分/ = 复合材料 (以前 RT + SABR) 计划的 30%。前瞻性研究，以验证这些预测和它们所基于的评分系统。

結果 (中文) 2:

PURPOSE: To determine the incidence of and risk factors for radiation pneumonitis (RP) after stereotactic ablative radiation therapy (SABR) to the lung in patients who had previously undergone conventional thoracic radiation therapy. METHODS AND MATERIALS: Seventy-two patients who had previously received conventionally fractionated radiation therapy to the thorax were treated with SABR (50 Gy in 4 fractions) for recurrent disease or secondary parenchymal lung cancer (T<4 cm, N0, M0, or Mx). Severe (grade>/=3) RP and potential predictive factors were analyzed by univariate and multivariate logistic regression analyses. A scoring system was established to predict the risk of RP. RESULTS: At a median follow-up time of 16 months after SABR (range, 4-56 months), 15 patients had severe RP (14 [18.9%] grade 3 and 1 [1.4%] grade 5) and 1 patient (1.4%) had a local recurrence. In univariate analyses, Eastern Cooperative Oncology Group performance status (ECOG PS) before SABR, forced expiratory volume in 1 second (FEV1), and previous planning target volume (PTV) location were associated with the incidence of severe RP. The V10 and mean lung dose (MLD) of the previous plan and the V10-V40 and MLD of the composite plan were also related to RP. Multivariate analysis revealed that ECOG PS scores of 2-3 before SABR (P=.009), FEV1/=30% of the composite plan (P=.021), and an initial PTV in the bilateral mediastinum (P=.025) were all associated with RP. CONCLUSIONS: We found that severe RP was relatively common, occurring in 20.8% of patients, and could be predicted by an ECOG PS score of 2-3, an FEV1/=30% on composite (previous RT+SABR) plans. Prospective studies are needed to validate these predictors and the scoring system on which they are based.

結果 (中文) 3:

目的：确定放射性肺炎的发病率和危险因素（RP）立体定向放射治疗后（SABR）对肺癌患者行常规胸部放射治疗。材料与方法：七零二例患者曾接受常规分割放射治疗胸部患者SABR（50 Gy的4次）治疗复发性疾病或继发性肺实质肿瘤（T＜4 cm，N0，M0，或MX）。通过单因素和多因素回归分析，对严重的（等级> / = 3）和潜在的预测因素进行了分析。设立评分系统预测RP的结果的风险：在16个月的中位随访时间后SABR（范围，4-56个月），15例患者有严重的RP（14 [ 18.9% ]和[ 1.4% ] 3级1级5）和1例（1.4%）有局部复发。在单变量分析中，东部肿瘤协作组（ECOG PS性能状态）在SABR之前，1秒钟用力呼气容积（FEV1），和以前的计划靶体积（PTV）的位置与严重的RP的V10和肺的平均剂量（MLD）发病相关的计划和v10-v40和MLD的复合计划也与RP的多变量分析表明，ECOG PS评分2-3在SABR（P = 009），FEV1 < / = 65%在SABR（P = 012），V20 > / = 30%的组合方案（P = 021），并在双侧纵隔初始PTV（P = 025）均与RP的结论：我们发现严重的RP是比较常见的，发生在20.8%的患者，可通过ECOG PS评分预测2-3、FEV1 <或= 65%，先前的PTV生成双侧纵隔和V20 > / = 30%复合（前RT + SABR）计划。未来的研究是必要的，以验证这些预测和评分系统，他们是基于。