Tokatli F, Kaya M, Kocak Z, Ture M, Mert S, Unlu E, Alkaya F, Cakir B
Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey.
Clin Oncol (R Coll Radiol). 2005 Feb;17(1):39-46. doi: 10.1016/j.clon.2004.07.012.
To determine the pulmonary effects of locoregional irradiation on clinical and sub-clinical radiographic and functional end points in women with breast cancer, and whether the course of these end points is affected by laterality.
Twenty patients (10 irradiated on the left side and 10 irradiated on the right side) were prospectively evaluated for changes in pulmonary function tests, Tc-99m DTPA (diethylenetriamine pentaacetic acid) lung clearance scintigraphy and high-resolution computed tomography (HRCT) at 6, 16 and 52 weeks after radiotherapy. Tc-99m DTPA clearance, expressed as the biological half-time, T(1/2), was computed from the time-activity curves for 10 min for each lung. The irradiated lung volume was calculated for each patient.
The mean irradiated lung volume was 6.4% +/- 2 (range 3-11%) for the entire population. In the whole study population, two (10%) patients, who were irradiated on the left side, had mild symptomatic radiation pneumonitis in the follow-up period. There was a statistically significant gradual reduction in all pulmonary function test values during the follow-up period. For patients irradiated on the left side, Tc-99m DTPA clearance T(1/2) values were statistically significantly decreased during the follow-up period (P = 0.03), but the decrease was not statistically significant for patients irradiated on the right side (P = 0.62). Tc-99m DTPA clearance T(1/2) values were statistically significantly decreased in the irradiated lung compared with the opposite lung, and no improvement was seen at week 52 after radiotherapy. The number of patients with changes on HRCT scans increased after radiotherapy, reaching a maximum at 16 weeks, when 80% of patients had changes. There was subsequent partial recovery 52 weeks after radiotherapy.
Locoregional irradiation for breast cancer may cause sub-clinical irreversible impairment of radiological and functional pulmonary parameters. The increase in clearance rate of Tc-99m DTPA may be more prominent for patients with left-sided breast cancer.
确定局部区域放疗对乳腺癌女性患者临床及亚临床影像学和功能终点的肺部影响，以及这些终点的病程是否受放疗侧别的影响。
前瞻性评估20例患者（左侧放疗10例，右侧放疗10例）放疗后6周、16周和52周时肺功能测试、锝-99m二乙三胺五乙酸（Tc-99m DTPA）肺清除闪烁显像及高分辨率计算机断层扫描（HRCT）的变化。从每个肺10分钟的时间-活性曲线计算出以生物半衰期T(1/2)表示的Tc-99m DTPA清除率。计算每位患者的受照射肺体积。
整组人群的平均受照射肺体积为6.4%±2（范围3-11%）。在整个研究人群中，左侧放疗的2例（10%）患者在随访期间出现轻度症状性放射性肺炎。随访期间所有肺功能测试值均有统计学意义的逐渐下降。对于左侧放疗的患者，随访期间Tc-99m DTPA清除率T(1/2)值有统计学意义的下降（P = 0.03），但右侧放疗患者的下降无统计学意义（P = 0.62）。与对侧肺相比，受照射肺的Tc-99m DTPA清除率T(1/2)值有统计学意义的下降，放疗后52周未见改善。放疗后HRCT扫描有变化的患者数量增加，在16周时达到峰值，此时80%的患者有变化。放疗后52周有部分恢复。
乳腺癌局部区域放疗可能导致影像学和功能肺参数的亚临床不可逆损害。对于左侧乳腺癌患者，Tc-99m DTPA清除率的增加可能更明显。
