Lind P A, Svane G, Gagliardi G, Svensson C
Department of Radiotherapy, Huddinge University Hospital, Stockholm, Sweden.
Int J Radiat Oncol Biol Phys. 1999 Feb 1;43(3):489-96. doi: 10.1016/s0360-3016(98)00414-3.
To study pulmonary radiological abnormalities with computer tomography (CT) following different radiotherapy (RT) techniques for breast cancer with respect to regions and density, and their correlation to pulmonary complications and reduction in vital capacity (VC).
CT scans of the lungs were performed prior to and 4 months following RT in 105 breast cancer patients treated with local or local-regional RT. The radiological abnormalities were analyzed with a CT-adapted modification of a classification system originally proposed by Arriagada, and scored according to increasing density (0-3) and affected lung regions (apical-lateral, central-parahilar, basal-lateral). The highest density grade in each region were added together to form scores ranging from 0-9. The patients were monitored for RT-induced pulmonary complications. VC was measured prior to and 5 months following RT.
Increasing CT scores were correlated with both local-regional RT and pulmonary complications (p < 0.001). The mean reduction of VC for patients scoring 4-9 (-202 ml) was larger than for patients scoring 0-3 (-2 ml) (p = 0.035). The effect of confounding factors on the radiological scoring was tested in the local-regional RT group. Scores of 4-9 were less frequently seen in the patients who had received adjuvant chemotherapy prior to RT. The importance of the respective lung regions on the outcome of pulmonary complications was tested. Only radiological abnormalities in the central-parahilar and apical-lateral regions were significantly correlated to pulmonary complications.
Radiological abnormalities detected on CT images and scored with a modification of Arriagada's classification system can be used as an objective endpoint for pulmonary side effects in breast cancer. The described model should, however, be expanded with information about the volume of lung affected in each region before definite conclusions can be drawn concerning each region's relative importance for the development of pulmonary complications. The negative association between sequential chemotherapy and radiological abnormalities should be confirmed in future studies.
采用计算机断层扫描（CT）研究不同放射治疗（RT）技术治疗乳腺癌后肺部的放射学异常，包括区域和密度方面，并探讨其与肺部并发症及肺活量（VC）降低的相关性。
对105例接受局部或局部区域放疗的乳腺癌患者在放疗前及放疗后4个月进行肺部CT扫描。采用对Arriagada最初提出的分类系统进行CT适应性修改的方法分析放射学异常，并根据密度增加程度（0 - 3级）和受影响的肺区域（尖侧、中央肺门旁、基底侧）进行评分。将每个区域的最高密度等级相加，形成0 - 9分的评分。对患者进行放疗引起的肺部并发症监测。在放疗前及放疗后5个月测量VC。
CT评分增加与局部区域放疗及肺部并发症均相关（p < 0.001）。评分为4 - 9分的患者VC平均降低量（-202 ml）大于评分为0 - 3分的患者（-2 ml）（p = 0.035）。在局部区域放疗组中测试了混杂因素对放射学评分的影响。放疗前接受辅助化疗的患者中，4 - 9分的情况较少见。测试了各个肺区域对肺部并发症结局的重要性。仅中央肺门旁和尖侧区域的放射学异常与肺部并发症显著相关。
CT图像上检测到的放射学异常并采用Arriagada分类系统的修改版进行评分，可作为乳腺癌肺部副作用的客观终点。然而，在就每个区域对肺部并发症发生发展的相对重要性得出明确结论之前，所描述的模型应补充每个区域受影响肺体积的信息。序贯化疗与放射学异常之间的负相关关系应在未来研究中得到证实。
