Marom Edith M, Martinez Carlos H, Truong Mylene T, Lei Xiudong, Sabloff Bradley S, Munden Reginald F, Gladish Gregory W, Herbst Roy S, Morice Rodolfo C, Stewart David J, Jimenez Carlos A, Blumenschein George R, Onn Amir
Department of Diagnostic Imaging, University of Texas, M. D. Anderson Cancer Center, Sheba Medical Center, Tel Hashomer, Israel.
J Thorac Oncol. 2008 Apr;3(4):351-7. doi: 10.1097/JTO.0b013e318168c7e9.
Treatment of lung cancer patients with antiangiogenesis agents is a new promising paradigm. Tumor cavitation is frequently noted in these patients, but the clinical significance of this finding has not been fully determined. Our purposes were to evaluate the frequency, imaging characteristics, and clinical outcome of patients receiving antiangiogenesis agents who develop tumor cavitation, and correlate these findings with therapy related adverse events, especially hemoptysis.
Retrospective analysis of lung cancer patients treated with antiangiogenesis agents in MD Anderson Cancer Center between June 1998 and June 2005. Clinical data were retrieved from medical records, and chest imaging findings were documented.
One hundred and twenty-four patients were treated in 10 different trials. All patients had advanced lung cancer and failed previous chemotherapy. Seventeen patients developed tumor cavitation during the trial (14%; median time to event, 1.8 months; range, 0.7-6.2 months), 16 patients (13%) had preexisting cavitary tumors, and 91 (73%) did not develop cavitation. Cavity formation was more common with squamous cell histology (p = 0.04) but was not associated with hemoptysis (p = 0.12), tumor location (central versus peripheral), imaging characteristics, progression-free survival (p = 0.56), or overall survival (p = 0.33). Hemoptysis was noted in five patients (median time to event, 1.3 months; range, 0.8-2.9 months). One of five patients with hemoptysis was fatal in a cavitary squamous cell tumor. Additional adverse events were hypertension, rash, and proteinuria, none associated with cavitation.
Development of tumor cavitation is not rare in lung cancer patients treated with antiangiogenesis agents, but the clinical implications are minimal in most cases.
使用抗血管生成药物治疗肺癌患者是一种新的有前景的模式。这些患者中经常出现肿瘤空洞，但这一发现的临床意义尚未完全确定。我们的目的是评估接受抗血管生成药物治疗且出现肿瘤空洞的患者的发生率、影像学特征和临床结局，并将这些发现与治疗相关不良事件（尤其是咯血）相关联。
对1998年6月至2005年6月在MD安德森癌症中心接受抗血管生成药物治疗的肺癌患者进行回顾性分析。从病历中检索临床数据，并记录胸部影像学检查结果。
124例患者参与了10项不同试验的治疗。所有患者均患有晚期肺癌且既往化疗失败。17例患者在试验期间出现肿瘤空洞（14%；事件发生的中位时间为1.8个月；范围为0.7 - 6.2个月），16例患者（13%）有预先存在的空洞性肿瘤，91例（73%）未出现空洞。空洞形成在鳞状细胞组织学类型中更常见（p = 0.04），但与咯血（p = 0.12）、肿瘤位置（中央型与周围型）、影像学特征、无进展生存期（p = 0.56）或总生存期（p = 0.33）无关。5例患者出现咯血（事件发生的中位时间为1.3个月；范围为0.8 - 2.9个月）。5例咯血患者中有1例死于空洞性鳞状细胞肿瘤。其他不良事件包括高血压、皮疹和蛋白尿，均与空洞形成无关。
接受抗血管生成药物治疗的肺癌患者中肿瘤空洞的形成并不罕见，但在大多数情况下临床意义极小。
