Ozawa Yuichi, Ida Masaki, Suda Takafumi, Fujii Masato, Kato Masato, Hasegawa Hirotsugu, Enomoto Noriyuki, Nogimura Hiroshi, Chida Kingo
Department of Internal Medicine and Thoracic Surgery, Haibara General Hospital.
Nihon Kokyuki Gakkai Zasshi. 2005 Feb;43(2):71-6.
Bronchiolitis obliterans organizing pneumonia (BOOP) primed by radiation therapy for the breast cancer (BOOP-RT/BC) has been recognized recently. In this study, we reported 9 such cases and discussed steroid therapy. Mean radiation dose and interval from completion of radiation therapy to the appearance of BOOP-RT/BC were 47.3 Gy and 5.6 months respectively. BOOP-RT/BC recurrence was observed by 5 episodes in 3 of 9 cases (recurrence rate was 33%). Steroid therapy showed a remarkable improvement in both primary and recurrent disease, and no residual symptom or BOOP shadow was detectable at the end of the observation except for shadows due to radiation fibrosis. All but one patient were prescribed prednisolone, with a mean initial dose of 32.5 mg/day and a mean treatment duration of 46.7 weeks. One patient improved without treatment. No case suffered from respiratory failure which needed mechanical ventilation or was motile. Considering these findings and the fact that almost all patients are middle aged or senior women who are susceptible to osteoporosis, we conclude that steroid therapy for BOOP-RT/BC should be carefully considered.
近期已认识到由乳腺癌放射治疗引发的闭塞性细支气管炎伴机化性肺炎(BOOP-RT/BC)。在本研究中,我们报告了9例此类病例并讨论了类固醇治疗。从放射治疗结束到BOOP-RT/BC出现的平均放射剂量和间隔时间分别为47.3 Gy和5.6个月。9例中有3例发生了5次BOOP-RT/BC复发(复发率为33%)。类固醇治疗在原发性和复发性疾病中均显示出显著改善,在观察结束时,除了放射纤维化导致的阴影外,未检测到残留症状或BOOP阴影。除1例患者外,所有患者均使用泼尼松龙,平均初始剂量为32.5 mg/天,平均治疗持续时间为46.7周。1例患者未经治疗病情改善。无一例患者出现需要机械通气或活动障碍的呼吸衰竭。考虑到这些发现以及几乎所有患者都是易患骨质疏松症的中年或老年女性这一事实,我们得出结论,对于BOOP-RT/BC的类固醇治疗应谨慎考虑。