Dimopoulou Ioanna, Galani Heleni, Dafni Urania, Samakovii Anastasia, Roussos Charis, Dimopoulos Meletios A
Department of Pulmonary and Critical Care, Evangelismos Hospital, Medical School, Athens, Greece.
Cancer. 2002 Jan 15;94(2):452-8. doi: 10.1002/cncr.10182.
Adverse effects of paclitaxel and carboplatin have been well described; however, pulmonary toxicity after patients receive this regimen has not been investigated extensively.
To clarify this issue, 33 consecutive patients who were treated with paclitaxel and carboplatin underwent prospective evaluation of respiratory function, which included pulmonary symptoms, pulmonary function tests (PFTs), arterial blood gas levels, and radiographic studies. Assessment was performed before and after completion of chemotherapy in all patients. Patients with substantial declines in PFTs, defined as a decline > or = 20 percent in forced expiratory volume in 1 second (FEV1), total lung capacity (TLC), or diffusion capacity for carbon monoxide (DLCO), were reassessed 5 months later.
After chemotherapy, there were no significant changes in forced vital capacity (FVC; 111%+/-21% of the predicted value before chemotherapy vs. 111+/-20% of the predicted value after chemotherapy), FEV1 (108%+/-24% of the predicted value before chemotherapy vs. 107%+/-22% of the predicted value after chemotherapy), FEV1/FVC ratio (79%+/-8% before chemotherapy vs. 78%+/-6% after chemotherapy), alveolar volume (VA; 95%+/-14% of the predicted value before chemotherapy vs. 96%+/-14% of the predicted value after chemotherapy), or TLC (96%+/-14% of the predicted value before chemotherapy vs. 97%+/-13% of the predicted value after chemotherapy). In contrast, there was a significant decline in DLCO (101%+/-20% of the predicted value before chemotherapy vs. 96+/-21% of the predicted value after chemotherapy; P < 0.05). Arterial blood gas levels did not change after treatment. No patient had decreased FEV1 or TLC levels by > or = 20%, whereas 4 of 33 patients (12%) exhibited a substantial decline (> or = 20%) in DLCO that persisted 5 months after treatment (DLCO at baseline, immediately after chemotherapy, and 5 months after the completion of chemotherapy, respectively: 99%+/-36% of the predicted value vs. 75%+/-28% of the predicted value vs. 74%+/-31% of the predicted value; P < 0.05). None of the 33 patients developed respiratory symptoms or had radiologic signs suggestive of lung toxicity. Among the various risk factors examined, baseline DLCO and FEV1 levels were associated with changes in DLCO post-treatment.
This prospective analysis showed that the combination of paclitaxel with carboplatin induced an isolated decrease in DLCO level in the absence of clinical or radiologic evidence of toxicity. Further studies are needed to clarify whether this reduction in DLCO is predictive of subsequent pulmonary impairment.
紫杉醇和卡铂的不良反应已有详尽描述；然而，患者接受该治疗方案后的肺部毒性尚未得到广泛研究。
为阐明这一问题，对连续33例接受紫杉醇和卡铂治疗的患者进行了呼吸功能的前瞻性评估，评估内容包括肺部症状、肺功能测试（PFTs）、动脉血气水平及影像学检查。所有患者在化疗完成前后均进行了评估。对于PFTs显著下降（定义为1秒用力呼气量（FEV1）、肺总量（TLC）或一氧化碳弥散量（DLCO）下降≥20%）的患者，在5个月后进行了重新评估。
化疗后，用力肺活量（FVC；化疗前为预测值的111%±21%，化疗后为预测值的111±20%）、FEV1（化疗前为预测值的108%±24%，化疗后为预测值的107%±22%）、FEV1/FVC比值（化疗前为79%±8%，化疗后为78%±6%）、肺泡容积（VA；化疗前为预测值的95%±14%，化疗后为预测值的96%±14%）或TLC（化疗前为预测值的96%±14%，化疗后为预测值的97%±13%）均无显著变化。相比之下，DLCO有显著下降（化疗前为预测值的101%±20%，化疗后为预测值的96±21%；P<0.05）。治疗后动脉血气水平未改变。没有患者的FEV1或TLC水平下降≥20%，而33例患者中有4例（12%）的DLCO出现显著下降（≥20%），且在治疗后5个月仍持续存在（基线、化疗后即刻及化疗完成后5个月时的DLCO分别为预测值的99%±36%、75%±28%和74%±31%；P<0.05）。33例患者中无一例出现呼吸道症状或有提示肺部毒性的放射学征象。在检查的各种危险因素中，基线DLCO和FEV1水平与治疗后DLCO的变化相关。
这项前瞻性分析表明，紫杉醇与卡铂联合使用在无临床或放射学毒性证据的情况下导致DLCO水平单独下降。需要进一步研究以阐明DLCO的这种降低是否可预测随后的肺部损害。
