Department of Radiation Oncology, Taipei Medical University-Municipal Wan Fang Hospital, Taipei, Taiwan.
Eur J Cancer Care (Engl). 2010 Sep;19(5):631-5. doi: 10.1111/j.1365-2354.2009.01104.x. Epub 2009 Aug 25.
This study aimed to investigate the outcome in patients with aspiration pneumonia during definitive concurrent chemoradiotherapy for head and neck cancer. The data of 595 patients with head and neck cancer treated by chemoradiotherapy were reviewed. Forty-one patients were identified as developing symptomatic aspiration pneumonia during treatment and were analysed for this study. The definition of symptomatic aspiration pneumonia fit three criteria: (1) at least one event of aspiration during the treatment or evidence of grade 2 or above dysphagia during treatment; (2) clinical or radiographic signs of pneumonia or pneumonitis; and (3) no evidence of grade 4 haematological toxicity before the outbreak of pneumonia. Termination of allocated radiotherapy was noted in 10 patients. A treatment break was observed in 26 patients, whereas irradiation was prolonged more than 1 week in 11 patients. Logistic regression analysis showed the dysphagia score during the treatment course and the chest roentgenography pattern following symptomatic aspiration pneumonia were found to independently influence the outcome. Aspiration pneumonia occurring during chemoradiotherapy for head and neck cancer has a detrimental effect on the treatment outcome. Intensive medical care is essential for this group of patients with a dysphagia score of 3 during treatment and an unfavourable chest film pattern.
本研究旨在探讨头颈部癌症根治性同期放化疗期间并发吸入性肺炎患者的结局。回顾了 595 例接受放化疗的头颈部癌症患者的数据。其中 41 例患者在治疗过程中出现有症状的吸入性肺炎，并对此进行了分析。有症状的吸入性肺炎的定义符合以下三个标准：(1) 在治疗过程中至少发生一次吸入事件，或在治疗过程中出现 2 级或以上吞咽困难的证据；(2) 出现肺炎或放射性肺炎的临床或影像学征象；(3) 在肺炎发作前无 4 级血液学毒性的证据。10 例患者停止了分配的放疗。26 例患者观察到治疗中断，11 例患者照射时间延长超过 1 周。Logistic 回归分析显示，治疗过程中的吞咽困难评分和有症状吸入性肺炎后胸部 X 线表现独立影响结局。头颈部癌症同期放化疗期间发生的吸入性肺炎对治疗结局有不利影响。对于这组在治疗过程中吞咽困难评分为 3 分且胸部 X 线片表现不佳的患者，需要进行强化医疗护理。
