Villani F, Busia A, Villani M, Laffranchi A, Viviani S, Bonfante V
U.O. Pneumologia e Fisiopatologia Respiratoria, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milano, Italy.
Anticancer Res. 2009 Feb;29(2):777-83.
The combination of mediastinal radiotherapy (RT) and polychemotherapy (CT) regimens can produce late toxic pulmonary and cardiac effects which often remain at the subclinical level. The aim of the present study was to investigate the cardiopulmonary response to exercise in this kind of patient. Therefore, 126 patients suffering from Hodgkin's disease were investigated after a follow-up of at least 5 years from the completion of the combined treatment. Sixty-two patients had been submitted to ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)-RT, 40 to ABVD-MOPP (mechloretamine, vincristine, procarbazine, prednisone)-RT and 24 to VEBEP (vincristine, epidoxorubicin, bleomycin, cyclophosphamide, etoposide, prednisone)-RT. The patients were divided into three groups on the basis of respiratory function: group 1 (67 patients), normal spirometry and lung transfer function for carbon monoxide (DLCO); group 2 (52 patients), normal spirometry and DLCO less than 80% of predicted; and group 3 (7 patients), total lung capacity and DLCO less than 80% of predicted. The patients were submitted to respiratory function evaluation and 2D-echocardiography before exercise, and to the determination of cardiac output by the acetylene rebreathing method before and during symptom-limited exercise on a cycloergometer using an incremental protocol. The patients of group 3 and to a lesser extent the patients of group 2 showed, in comparison to patients of group 1, a lower tolerance to exercise, a lower oxygen consumption, a higher respiratory rate, a lower O2 pulse and a lower cardiac output per oxygen uptake. These data indicated an abnormal exercise physiology in the patients with persistent pulmonary impairment, especially when the reduction of DLCO was associated with a decrease of total lung capacity. The lower exercise capacity seems to be due to a combination of decreased cardiac performance and an impairment of gas diffusion capacity.
纵隔放疗（RT）和多药化疗（CT）方案联合使用会产生迟发性肺部和心脏毒性效应，这些效应通常处于亚临床水平。本研究的目的是调查这类患者对运动的心肺反应。因此，对126例霍奇金病患者进行了研究，这些患者在联合治疗结束后至少随访了5年。62例患者接受了ABVD（阿霉素、博来霉素、长春花碱、达卡巴嗪）-RT治疗，40例接受了ABVD-MOPP（氮芥、长春新碱、丙卡巴肼、泼尼松）-RT治疗，24例接受了VEBEP（长春新碱、表柔比星、博来霉素、环磷酰胺、依托泊苷、泼尼松）-RT治疗。根据呼吸功能将患者分为三组：第1组（67例患者），肺量计检查和一氧化碳肺转运功能（DLCO）正常；第2组（52例患者），肺量计检查正常，DLCO低于预测值的80%；第3组（7例患者），肺总量和DLCO低于预测值的80%。患者在运动前接受呼吸功能评估和二维超声心动图检查，并在使用递增方案在自行车测力计上进行症状限制性运动之前和期间，通过乙炔再呼吸法测定心输出量。与第1组患者相比，第3组患者以及程度较轻的第2组患者表现出运动耐受性较低、耗氧量较低、呼吸频率较高、氧脉搏较低以及每摄氧量的心输出量较低。这些数据表明，持续存在肺部损伤的患者存在异常的运动生理学，尤其是当DLCO降低与肺总量减少相关时。较低的运动能力似乎是由于心脏功能下降和气体扩散能力受损共同导致的。
