Petit Sandrine, Lortholary Alain, Troussier Jacques, Tuchais Claude
Service d'oncologie radiothérapie, Centre Paul Papin, Angers.
Presse Med. 2005 Apr 9;34(7):506-8. doi: 10.1016/s0755-4982(05)83959-4.
Pulmonary complications of radiotherapy are rare, but bronchiolitis obliterans organizing pneumonia (BOOP) is observed in 2.5% of cases. It can develop after radiation treatment of breast cancer as well as, more rarely, lung cancer, sarcoma, Hodgkin's disease or malignant thymoma.
Ten months after radiotherapy for breast cancer, a 52 year-old woman developed migratory alveolar opacities outside the radiation field. Their improvement with corticosteroid treatment led to the diagnosis of BOOP.
BOOP, which resembles infectious pneumonia, can develop 2-7 months after the end of radiotherapy and is seen especially in women aged 50-60 years with fever and coughs resistant to antibiotics. Dyspnea is far rarer. Imaging reveals patchy infiltrates with widespread bilateral, mobile lesions extended over and above the radiation field. Biopsy is required to confirm diagnosis; sections, which may or may not come from the radiation field, reveal the nonspecific granulomatous alveolar infiltrates typical of BOOP. Other causes should be eliminated (toxic, immune, iatrogenic or even idiopathic infection and recurrent early neoplastic relapse). Association with hormone therapy does not influence the course of BOOP. Outcome with corticosteroid treatment is excellent.
放疗的肺部并发症较为罕见，但闭塞性细支气管炎伴机化性肺炎（BOOP）在2.5%的病例中可见。它可在乳腺癌放疗后发生，在肺癌、肉瘤、霍奇金病或恶性胸腺瘤放疗后发生则更为罕见。
一名52岁女性在乳腺癌放疗十个月后，在放疗野之外出现了游走性肺泡实变影。糖皮质激素治疗后病情改善，从而诊断为BOOP。
BOOP类似感染性肺炎，可在放疗结束后2至7个月发生，尤其见于50至60岁、对抗生素治疗无效的发热和咳嗽女性患者。呼吸困难则极为罕见。影像学显示斑片状浸润影，双侧广泛分布且病变可移动，超出放疗野范围。确诊需要活检；活检组织（可能来自也可能不来自放疗野）显示出BOOP典型的非特异性肉芽肿性肺泡浸润。应排除其他病因（中毒、免疫、医源性，甚至特发性感染及早期肿瘤复发）。与激素治疗的联合使用并不影响BOOP的病程。糖皮质激素治疗效果极佳。
