Halme M, Hallman M, Ruotsalainen T, Piilonen A, Taskinen E, Pekonen M, Maasilta P, Mattson K
Department of Medicine, Helsinki University Central Hospital, Finland.
Lung Cancer. 1999 Jan;23(1):39-52. doi: 10.1016/s0169-5002(98)00092-0.
The aim of this study was to determine whether either natural or recombinant interferon (IFN)-alpha can improve the response to radiotherapy (RT) in patients with small cell lung cancer (SCLC), and to assess the role of IFN in radiation-induced lung injury. All patients had previously participated in a randomised trial of chemotherapy alone or in combination with IFN-alpha in three arms (arm O: no IFN, arm I: natural IFN-alpha, arm II: recombinant IFN-alpha). Patients with locally progressive disease in the lungs following chemotherapy were treated with RT and they continued with their concomitant IFN-alpha. The RT dose was 50 Gy. Radiation-induced lung injury was assessed by lung function tests, computed tomography and bronchoalveolar lavage fluid (BALF) analysis which included cell findings, Interleukin (IL)-1 alpha/-1 beta expression by alveolar macrophages and surfactant components. Seventeen patients were entered in the study, 16 of whom were evaluable. Response rates in Arms O, I and II were 50, 67 and 50%, respectively. Median survival was 18.5, 7 and 23 months respectively, and 1-year survival was 67, 29 and 75% respectively. Long-term survival as assessed by 2- and 3-year survival rates was 29% in patients receiving natural IFN-alpha as compared to 17% in patients not receiving IFN (not statistically significant findings). Every patient had abnormal results when assessed for radiation-induced lung injury. No statistically significant difference was found in toxicity between the treatment arms. A high surfactant protein (SP)-A/phospholipid ratio and a high level of SP-A in BALF before RT was associated with a high degree of radiation-induced lung injury measured by lung function tests and computed tomography in all arms of the study. Thus, we could not show that the combination of IFN-alpha and RT induced more lung toxicity than RT alone as we did in our previous study. The role of high SP-A/phospholipid ratios and high SP-A levels in BALF before RT as predictors of the development of lung injury after RT needs to be determined in the future.
本研究的目的是确定天然或重组干扰素（IFN）-α能否改善小细胞肺癌（SCLC）患者对放疗（RT）的反应，并评估IFN在放射性肺损伤中的作用。所有患者此前均参与了一项随机试验，该试验分为三个组，分别为单纯化疗组或化疗联合IFN-α组（组O：不使用IFN，组I：天然IFN-α，组II：重组IFN-α）。化疗后肺部出现局部进展性疾病的患者接受了放疗，并继续使用其相应的IFN-α。放疗剂量为50 Gy。通过肺功能测试、计算机断层扫描和支气管肺泡灌洗（BALF）分析来评估放射性肺损伤，BALF分析包括细胞检查、肺泡巨噬细胞白细胞介素（IL）-1α/-1β表达以及表面活性物质成分。17名患者进入本研究，其中16名可评估。组O、组I和组II的缓解率分别为50%、67%和50%。中位生存期分别为18.5个月、7个月和23个月，1年生存率分别为67%、29%和75%。通过2年和3年生存率评估的长期生存率，接受天然IFN-α的患者为29%，未接受IFN的患者为17%（无统计学显著差异）。在评估放射性肺损伤时，每位患者的结果均异常。各治疗组之间在毒性方面未发现统计学显著差异。放疗前BALF中高表面活性蛋白（SP）-A/磷脂比值和高SP-A水平与通过肺功能测试和计算机断层扫描测量的所有研究组中高度的放射性肺损伤相关。因此，我们无法证明IFN-α与放疗联合使用比单独放疗诱导更多的肺毒性，正如我们之前的研究所显示的那样。放疗前BALF中高SP-A/磷脂比值和高SP-A水平作为放疗后肺损伤发生的预测指标的作用，有待未来确定。
Zotero 插件