Matsuno Yosuke, Satoh Hiroaki, Ishikawa Hiroichi, Kodama Takahide, Ohtsuka Morio, Sekizawa Kiyohisa
Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan.
Med Oncol. 2006;23(1):75-82. doi: 10.1385/MO:23:1:75.
Radiation pneumonitis (RP) is a serious complication in patients undergoing thoracic radiotherapy (TRT). Serum KL-6 and SP-D have been shown to increase in several kinds of interstitial pneumonia. To evaluate their clinical usefulness in detecting RP, we serially measured them in patients receiving TRT.
Thirty-nine patients, who received TRT for lung cancer between July 1999 and April 2004, were prospectively studied. Serum levels of KL-6 and SP-D were measured using enzyme-linked immunosorbent assays. Patients were followed up until August 2004 or their deaths.
During the period, RP occurred in 19 patients. In five patients with diffuse RP extended outside the radiation field, serum KL-6 levels increased, reaching more than 1,000 U/mL. Serum KL-6 levels at 40 Gy in patients who developed RP were higher than those without it (p = 0.0363, Mann-Whitney U test). In addition, serum KL-6 levels at 40 Gy in patients who developed RP were higher than those of pretreatment (p = 0.0126, Wilcoxon signed rank test). On the other hand, there were no statistical differences between sp-d at 40 Gy and those before TRT (P = 0.1165).
Increased KL-6 at 40 Gy compared with those before treatment in patients undergoing TRT may be of clinical significance. KL-6 proved to be a useful indicator for estimating RP, while usefulness of SP-D was not confirmed in this study.
放射性肺炎（RP）是接受胸部放疗（TRT）患者的一种严重并发症。血清KL-6和SP-D在几种间质性肺炎中已显示升高。为评估它们在检测RP中的临床实用性，我们对接受TRT的患者进行了连续检测。
对1999年7月至2004年4月期间因肺癌接受TRT的39例患者进行前瞻性研究。采用酶联免疫吸附测定法测量血清KL-6和SP-D水平。对患者随访至2004年8月或直至其死亡。
在此期间，19例患者发生了RP。5例弥漫性RP扩展至放疗野外的患者，血清KL-6水平升高，超过1000 U/mL。发生RP的患者在40 Gy时的血清KL-6水平高于未发生RP的患者（p = 0.0363，曼-惠特尼U检验）。此外，发生RP的患者在40 Gy时的血清KL-6水平高于治疗前（p = 0.0126，威尔科克森符号秩检验）。另一方面，40 Gy时的SP-D与TRT前相比无统计学差异（P = 0.1165）。
接受TRT的患者在40 Gy时KL-6水平较治疗前升高可能具有临床意义。KL-6被证明是评估RP的有用指标，而本研究未证实SP-D的实用性。
