A Clinical Study Of Lung Injury Evaluation Of The Concurrent Chemoradiotherapy For Locally Advanced Non-Small Cell Lung Cancer With DVH Parameters(V20 And V30)

Objective:(1)To research the short-term efficacy of 3D-CRT/Taxol +Carboplatin and the degree of lung injury by comparing concurrent chemoradiotherapy(3D-CRT/Taxol+Carboplatin)with sequential chemoradio- therapy for locally advanced non-small cell lung cancer;(2)To research the correlation between the dose-volume histogram (DVH) parameters (V20 and V30) and lung injury;(3)To explore the correlation between lung injury degree in concurrent chemoradiotherapy and DVH parameters (V30 and V20) ;(4)To research the relations with probability of lung injury and DVH parameters in concurrent chemoradiotherapy ;(5)To optimize the treatment project and clinical direction.Methods : From April 2004 to January 2008,66 cases of patients (Clinical stages: IIIa stage and IIIb stage) were randomly allocated into concurrent chemoradiotherapy group (36 cases ) and sequential Chemoradiotherapy group (30 cases ). (1) Radiotherapy Ways : 3D-CRT,Conventional fractionation was 2 Gy/frack(F), 5 times/week, as concurrent chemoradiotherapy group total dose was 66-70Gy/30-33F and sequential Chemoradiotherapy group total dose was 60-70Gy/30-35F.(2)Chemotherapy program:①The concurrent chemoradio- therapy group: chemotherapy was conducted in the beginning 24 hours of radiotherapy, then chemotherapy was repeated for 2 cycles (3 weeks/cycle), and the same chemotherapy was conducted for another two cycles after the chemoradiotherapy;②The sequential chemoradiotherapy group :chemotherapy was repeated continuously for 2 cycles ( 3 weeks/cycle) before radiotherapy, then radiotherapy started, after radiotherapy the same chemotherapy was conducted for another two cycles. Chemotherapy Ways: Taxol 175mg/m2 iv.dirp d1,d22, Carboplatin (AUC=6mg/ml·min) iv.dirp d1,d22; Then the correlation of DVH parameters (V30 and V20) with the lung injury was evaluated.Results:(1)By comparing concurrent chemoradiotherapy group with sequential chemoradiotherapy group, the efficiency(CR+PR) was 77.78% VS 50.00% (p<0.05) with an increase of 27.78%, one-year survival rate was 63.89% VS 53.33% (p>0.05) with an increase of 10.56%;(2)By comparing concurrent chemoradiotherapy group with sequential chemoradiotherapy group, the incidence of the≥Grade II grade lung injury was 36.11% VS 20.00% (p<0.05) with the aggravation degree of 16.11% ;(3)the results of logistic regression of multi-factors,show that only the whole lung DVH parameter (20 and V30) has relation to≥Grade II lung injury (P<0.05);(4)In the concurrent chemoradiotherapy group, by analysing single-factor correlation between DVH parameters (V20 and V30) and≥Grade II lung injury,correlation coefficient between V20 and≥Grade II lung injury was 0.740 (P = 0.004),a high positive correlation;correlation coefficient between V30 and≥Grade II lung injury was 0.705(P=0.007),a high positive correlation; the formor was higher than the latter;(5)For the concurrent chemoradiotherapy group, the probability of≥Grade II lung injury were respectively 17.64% and 52.63% in V20≤25.00% and V20>25.00% groups(p<0.05); the probability of≤Grade II lung injury was respectively 16.67% and 55.56% in V30≤18.00% group and V30>18.00% group (p<0.05).Conclusions:(1)3D-CRT/Taxol+Carboplatin concurrent chemoradiother- apy can improve short-term efficacy, but increases lung injury;(2)DVH parameter (V20 and V30) is closely related to lung injury; (3)DVH parameter (V20 and V30) can be used to predicte the degree of lung injury in concurrent chemoradiotherapy ;(4)DVH parameter (V20 and V30) can be used to estimate the probability of lung injury in the concurrent chemoradiotherapy group, (5) In the concurrent chemoradiotherapy group, V20>25.00% and V30>18.00% requires modification of treatment programs to cut down V20 and V30 , or even give up the designed treatment project. As the dose parameter for evaluating the quality of treatment project, maybe V20 is superior to V30.