Kong Feng-Ming, Ten Haken Randall, Eisbruch Avraham, Lawrence Theodore S
Department of Radiation Oncology, University of Michigan, UH-B2C490, Box 0010, 1300 E. Medical Center Drive, Ann Arbor, MI 48109, USA.
Semin Oncol. 2005 Apr;32(2 Suppl 3):S42-54. doi: 10.1053/j.seminoncol.2005.03.009.
Successful treatment of non-small cell lung cancer requires adequate local and systemic disease control. Although it has been shown to have superior results, high-dose radiation therapy is not a current practice largely because of concerns of normal tissue toxicity. This article reviews and updates the possible mechanism of radiation-induced pneumonitis and fibrosis, their associations with dose intensity, and the role they may play in making treatment decisions. The commonly used clinical terminology and grading systems are summarized. Pneumonitis and fibrosis after 3-dimensional conformal high-dose radiation are reviewed, including recent updates from radiation dose escalation trials. Chemotherapy- and chemoradiation-related lung toxicities are also discussed. Individual susceptibility and potential predictive models are examined; dose and 3-dimensional dosimetric parameters are reviewed along with estimation of normal tissue complication probability and biologic predictive assays. Based on the risk levels of toxicity for each patient, future clinical trials may be designed to maximize individual therapeutic gain.
成功治疗非小细胞肺癌需要对局部和全身疾病进行充分控制。尽管高剂量放射治疗已被证明具有更好的效果，但目前它并非普遍应用的治疗方法，主要原因是担心正常组织毒性。本文回顾并更新了放射性肺炎和肺纤维化的可能机制、它们与剂量强度的关联以及在治疗决策中可能发挥的作用。总结了常用的临床术语和分级系统。回顾了三维适形高剂量放疗后的肺炎和肺纤维化，包括放疗剂量递增试验的最新进展。还讨论了化疗和放化疗相关的肺部毒性。研究了个体易感性和潜在的预测模型；回顾了剂量和三维剂量学参数，以及正常组织并发症概率的估计和生物学预测分析。根据每位患者的毒性风险水平，未来可设计临床试验以最大化个体治疗获益。
