Kahán Zsuzsanna, Csenki Melinda, Varga Zoltán, Szil Elemér, Cserháti Adrienn, Balogh Attila, Gyulai Zsófia, Mándi Yvette, Boda Krisztina, Thurzó László
Department of Oncotherapy, University of Szeged, Szeged, Hungary.
Int J Radiat Oncol Biol Phys. 2007 Jul 1;68(3):673-81. doi: 10.1016/j.ijrobp.2006.12.016. Epub 2007 Mar 9.
To study the risks of early and late radiogenic lung damage in breast cancer patients after conformal radiotherapy.
Radiogenic lung sequelae were assessed prospectively in 119 patients by means of clinical signs, radiologic abnormalities, and the mean density change (MDC) of the irradiated lung on CT.
Significant positive associations were detected between the development of lung abnormalities 3 months or 1 year after the radiotherapy and the age of the patient, the ipsilateral mean lung dose (MLD), the radiation dose to 25% of the ipsilateral lung (D(25%)) and the volume of the ipsilateral lung receiving 20 Gy (V(20 Gy)). The irradiation of the axillary and supraclavicular lymph nodes favored the development of pneumonitis but not that of fibrosis. No relation was found between the preradiotherapy plasma TGF-beta level and the presence of radiogenic lung damage. At both time points, MDC was strongly related to age. Significant positive associations were demonstrated between the risks of pneumonitis or fibrosis and the age of the patient, MLD, D(25%), and V(20 Gy). A synergistic effect of MLD, D(25%), and V(20 Gy) with age in patients older than 59 years is suggested.
Our analyses indicate that the risks of early and late radiogenic lung sequelae are strongly related to the age of the patient, the volume of the irradiated lung, and the dose to it.
研究乳腺癌患者在适形放疗后发生早期和晚期放射性肺损伤的风险。
通过临床体征、影像学异常以及CT上受照射肺的平均密度变化（MDC）对119例患者的放射性肺后遗症进行前瞻性评估。
放疗后3个月或1年时肺部异常的发生与患者年龄、同侧平均肺剂量（MLD）、同侧25%肺组织的辐射剂量（D(25%)）以及接受20 Gy照射的同侧肺体积（V(20 Gy)）之间存在显著正相关。腋窝和锁骨上淋巴结的照射有利于肺炎的发生，但对纤维化的发生无影响。放疗前血浆转化生长因子-β水平与放射性肺损伤的存在之间未发现关联。在两个时间点，MDC均与年龄密切相关。肺炎或纤维化的风险与患者年龄、MLD、D(25%)和V(20 Gy)之间存在显著正相关。提示在年龄大于59岁的患者中，MLD、D(25%)和V(20 Gy)与年龄存在协同作用。
我们的分析表明，早期和晚期放射性肺后遗症的风险与患者年龄、受照射肺的体积及其所接受的剂量密切相关。
