Naito Yoichi, Tsuchiya Satoshi, Ishihara Shinichi, Minato Koichi, Shitara Yoshinori, Takise Atsushi, Suga Tatsuo, Mogi Akira, Yamabe Katsumi, Saito Ryusei
Division of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Am J Clin Oncol. 2008 Aug;31(4):340-4. doi: 10.1097/COC.0b013e318162f13b.
Although preexisting pulmonary fibrosis (PF) on chest radiograph is known to be a risk factor of gefitinib-related interstitial lung disease (ILD), the significance of PF detected by chest computed tomography (CT) on the development of gefitinib-related ILD has not been investigated sufficiently.
We reviewed 182 nonsmall cell lung cancer patients treated with gefitinib between July 2002 and March 2003. Chest radiographs and CT were taken in all patients periodically and reviewed by radiologists. PF was defined as ground-glass attenuation, consolidation, or reticular shadow without segmental distribution. Gefitinib-related ILD was defined as the acute respiratory failure developed during the course of gefitinib administration and lack of evidence for other cause of respiratory failure. Expected risk factors for gefitinib-related ILD were evaluated in multivariate analysis.
There were 15 patients with PF. Nine PF were detected on both chest radiograph and chest CT, and 6 on only chest CT. Twelve patients (6.6%) developed ILD during the course of gefitinib monotherapy and 4 died of it. Univariate and multivariate analyses showed that PF detected on chest radiograph was found to be the only significant risk factor for developing ILD (32.2, P < 0.001). Preexisting fibrosis diagnosed on chest CT but not apparent on chest radiograph was not significantly correlated with ILD.
Gefitinib should not be given to patients with PF apparent on chest radiograph. Patients with PF on chest CT but not detected on chest radiograph could be treated carefully with gefitinib, but a risk-benefit analysis should be considered.
虽然胸部X线片上预先存在的肺纤维化（PF）是吉非替尼相关间质性肺病（ILD）的一个危险因素，但胸部计算机断层扫描（CT）检测到的PF对吉非替尼相关ILD发生发展的意义尚未得到充分研究。
我们回顾了2002年7月至2003年3月期间接受吉非替尼治疗的182例非小细胞肺癌患者。所有患者定期进行胸部X线片和CT检查，并由放射科医生进行复查。PF定义为无节段分布的磨玻璃影、实变或网状阴影。吉非替尼相关ILD定义为在吉非替尼给药过程中出现的急性呼吸衰竭且缺乏呼吸衰竭其他病因的证据。在多变量分析中评估吉非替尼相关ILD的预期危险因素。
有15例患者存在PF。9例PF在胸部X线片和胸部CT上均被检测到，6例仅在胸部CT上被检测到。12例患者（6.6%）在吉非替尼单药治疗过程中发生ILD且4例死于该病。单变量和多变量分析显示，胸部X线片上检测到的PF是发生ILD的唯一显著危险因素（32.2，P<0.001）。胸部CT诊断出但胸部X线片上不明显的预先存在的纤维化与ILD无显著相关性。
胸部X线片上明显存在PF的患者不应给予吉非替尼。胸部CT上存在PF但胸部X线片上未检测到的患者可以谨慎使用吉非替尼治疗，但应考虑进行风险效益分析。
