不可切除的非小细胞肺癌放疗后大出血：支气管内近距离放疗真的是一个危险因素吗？
Massive haemoptysis after radiotherapy in inoperable non-small cell lung carcinoma: is endobronchial brachytherapy really a risk factor?
作者信息
Langendijk J A, Tjwa M K, de Jong J M, ten Velde G P, Wouters E F
机构信息
Radiotherapeutisch Instituut Limburg, Heerlen, The Netherlands.
出版信息
Radiother Oncol. 1998 Nov;49(2):175-83. doi: 10.1016/s0167-8140(98)00103-0.
BACKGROUND AND PURPOSE
This retrospective study was conducted to investigate whether endobronchial brachytherapy (EBB) is a risk factor for massive haemoptysis in patients primarily treated by a combination of EBB and external irradiation (XRT) for NSCLC.
MATERIALS AND METHODS
The records of 938 patients with inoperable NSCLC who were treated with XRT and/or EBB were reviewed. The patients were divided into five groups as follows: group XRT, treated by XRT alone (n = 421); group XRTelig, treated by XRT but eligible for EBB (n = 419); group XRTEBB, primarily treated with EBB+XRT (n = 62); group EBBrec, treated by EBB for recurrence after XRT (n = 23); and group EBB, treated by EBB alone (n = 13). EBB was delivered using HDR. Patients with bronchoscopy-proven endobronchial tumour in the proximal airways, i.e. the trachea, the main bronchus or lobar bronchus were considered eligible for EBB.
RESULTS
One hundred one out of 938 patients (10.8%) died from massive haemoptysis. The incidence was 4.3% in group XRT, 13.1% in group XRTelig and 25.4% in group XRTEBB. The differences between groups XRT and XRTelig as well as between groups XRTelig and XRTEBB were statistically significant (P<0.01). The incidence of massive haemoptysis depended significantly on the fraction size of brachytherapy. When two fractions of 7.5 Gy or a single fraction of 10 Gy were used, 11.1% of the patients died from massive haemoptysis. However, when a single dose of 15 Gy was used, 47.8% died from massive haemoptysis. In the multivariate analysis, a single dose of 15 Gy EBB was the most important prognostic factor for massive haemoptysis.
CONCLUSION
XRT+EBB as primary treatment for NSCLC does not lead to a higher risk of massive haemoptysis as compared to XRT alone when fraction sizes for EBB of 7.5 or 10 Gy are used. However, the risk of massive haemoptysis increases dramatically when a fraction size of 15 Gy is used.
背景与目的
本回顾性研究旨在调查对于主要采用支气管内近距离放射疗法（EBB）与外照射（XRT）联合治疗的非小细胞肺癌（NSCLC）患者，支气管内近距离放射疗法是否为大量咯血的危险因素。
材料与方法
回顾了938例接受XRT和/或EBB治疗的无法手术的NSCLC患者的记录。患者被分为以下五组：XRT组，仅接受XRT治疗（n = 421）；XRTelig组，接受XRT治疗但符合EBB条件（n = 419）；XRTEBB组，主要接受EBB + XRT治疗（n = 62）；EBBrec组，在XRT后复发接受EBB治疗（n = 23）；EBB组，仅接受EBB治疗（n = 13）。EBB采用高剂量率（HDR）进行。经支气管镜证实近端气道（即气管、主支气管或叶支气管）存在支气管内肿瘤的患者被认为符合EBB治疗条件。
结果
938例患者中有101例（10.8%）死于大量咯血。XRT组的发生率为4.3%，XRTelig组为13.1%，XRTEBB组为25.4%。XRT组与XRTelig组之间以及XRTelig组与XRTEBB组之间的差异具有统计学意义（P<0.01）。大量咯血的发生率显著取决于近距离放射疗法的分次剂量。当采用两个7.5 Gy分次或单次10 Gy时，11.1%的患者死于大量咯血。然而，当采用单次15 Gy剂量时，47.8%的患者死于大量咯血。在多变量分析中，单次15 Gy的EBB是大量咯血最重要的预后因素。
结论
当EBB的分次剂量为7.5或10 Gy时，与单纯XRT相比，XRT + EBB作为NSCLC的主要治疗方法不会导致更高的大量咯血风险。然而，当采用15 Gy的分次剂量时，大量咯血的风险会急剧增加。
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