Gopal Ramesh, Starkschall George, Tucker Susan L, Cox James D, Liao Zhongxing, Hanus Michael, Kelly Jason F, Stevens Craig W, Komaki Ritsuko
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Int J Radiat Oncol Biol Phys. 2003 May 1;56(1):114-20. doi: 10.1016/s0360-3016(03)00077-4.
To evaluate the effects of chemoradiation on objective tests of pulmonary function.
One hundred lung cancer patients treated in five protocols between 1992 and 2000 with combinations of thoracic radiotherapy (RT) and chemotherapy were evaluated with pre- and post-RT pulmonary function tests. The pulmonary function tests were analyzed for changes in measures of obstruction (forced expiratory volume in 1 s per unit of vital capacity [FEV(1)/VC]), restriction (total lung capacity [TLC]), and diffusing capacity (diffusing capacity for carbon monoxide [DLCO]). The use and timing of chemotherapy and RT, as well as patient, tumor, and treatment factors, were evaluated using univariate and multivariate analyses.
No treatment or patient factors were significantly associated with changes in FEV(1)/VC. Chemotherapy with RT, compared with RT alone, was associated with a lower post-RT TLC (92% vs. 107%, p = 0.002). Nodal status (N2-N3 vs. N1), tumor location (central vs. peripheral), use of >/=6 treatment fields, and tumor volume >/=100 cm(3) were also associated with a significantly lower post-RT TLC. On univariate analysis, the use of any chemotherapy (p = 0.029) and the use of concurrent vs. sequential chemotherapy (p = 0.028) were predictive of a lower post-RT DLCO. Patient age >/=60 years, nodal status (N2-N3 vs. N0-N1), tumor volume >/=100 cm(3), tumor location (central vs. peripheral), and use of >/=6 treatment fields were also associated with a significantly lower post-RT DLCO. The fractional volume of irradiated normal lung correlated with the decrease in DLCO (p <0.001), with a 1.3% DLCO decline for each 1% of total lung volume that received >20 Gy.
The addition of chemotherapy to RT significantly exacerbates the post-RT decrease in TLC and DLCO. The greatest decrease in DLCO occurs in patients treated with concurrent chemoradiation.
评估放化疗对肺功能客观测试的影响。
1992年至2000年间，对采用胸部放疗（RT）和化疗联合方案治疗的100例肺癌患者，在放疗前后进行肺功能测试评估。分析肺功能测试中阻塞指标（每单位肺活量的1秒用力呼气量[FEV(1)/VC]）、限制指标（肺总量[TLC]）和弥散功能指标（一氧化碳弥散量[DLCO]）的变化。采用单因素和多因素分析评估化疗和放疗的使用及时间安排，以及患者、肿瘤和治疗因素。
未发现治疗或患者因素与FEV(1)/VC的变化有显著相关性。与单纯放疗相比，放化疗后TLC较低（92%对107%，p = 0.002）。淋巴结状态（N2 - N3对N1）、肿瘤位置（中央型对周围型）、使用≥6个治疗野以及肿瘤体积≥100 cm(3)也与放疗后TLC显著降低相关。单因素分析显示，使用任何化疗（p = 0.029）以及同步化疗与序贯化疗的使用（p = 0.028）可预测放疗后DLCO较低。患者年龄≥60岁、淋巴结状态（N2 - N3对N0 - N1）、肿瘤体积≥100 cm(3)、肿瘤位置（中央型对周围型）以及使用≥6个治疗野也与放疗后DLCO显著降低相关。照射的正常肺组织分数体积与DLCO的降低相关（p <0.001），每1%接受>20 Gy照射的全肺体积，DLCO下降1.3%。
放疗联合化疗显著加剧放疗后TLC和DLCO的下降。同步放化疗患者的DLCO下降最为明显。
