Department of Radiology, University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo, Japan.
Radiat Oncol. 2010 May 9;5:32. doi: 10.1186/1748-717X-5-32.
To determine the risk factors of severe radiation pneumonitis (RP) after stereotactic body radiation therapy (SBRT) for primary or secondary lung tumors.
From January 2003 to March 2009, SBRT was performed on 117 patients (32 patients before 2005 and 85 patients after 2006) with lung tumors (primary = 74 patients and metastatic/recurrent = 43 patients) in our institution. In the current study, the results on cases with severe RP (grades 4-5) were evaluated. Serum Krebs von den Lungen-6 (KL-6) and serum Surfactant protein-D (SP-D) were used to predict the incidence of RP. A shadow of interstitial pneumonitis (IP) on the CT image before performing SBRT was also used as an indicator for RP. Since 2006, patients have been prescreened for biological markers (KL-6 & SP-D) as well as checking for an IP-shadow in CT.
Grades 4-5 RP was observed in nine patients (7.7%) after SBRT and seven of these cases (6.0%) were grade 5 in our institution. A correlation was found between the incidence of RP and higher serum KL-6 & SP-D levels. IP-shadow in patient's CT was also found to correlate well with the severe RP. Severe RP was reduced from 18.8% before 2005 to 3.5% after 2006 (p = 0.042). There was no correlation between the dose volume histogram parameters and these severe RP patients.
Patients presenting with an IP shadow in the CT and a high value of the serum KL-6 & SP-D before SBRT treatment developed severe radiation pneumonitis at a high rate. The reduction of RP incidence in patients treated after 2006 may have been attributed to prescreening of the patients. Therefore, pre-screening before SBRT for an IP shadow in CT and serum KL-6 & SP-D is recommended in the management and treatment of patients with primary or secondary lung tumors.
确定原发性或继发性肺肿瘤立体定向体部放疗（SBRT）后重度放射性肺炎（RP）的危险因素。
自 2003 年 1 月至 2009 年 3 月，对我机构的 117 例（2005 年前 32 例，2006 年后 85 例）肺肿瘤（原发性=74 例，转移性/复发性=43 例）患者进行 SBRT。在本研究中，评估了重度 RP（4-5 级）病例的结果。血清 Krebs von den Lungen-6（KL-6）和血清表面活性蛋白-D（SP-D）用于预测 RP 的发生率。SBRT 前 CT 图像上的间质性肺炎（IP）阴影也被用作 RP 的指标。自 2006 年以来，患者已经接受了生物标志物（KL-6 和 SP-D）筛选以及 CT 检查 IP 阴影的预筛选。
SBRT 后 9 例（7.7%）发生 4-5 级 RP，其中 7 例（6.0%）为 5 级。RP 的发生率与较高的血清 KL-6 和 SP-D 水平相关。患者 CT 上的 IP 阴影也与重度 RP 密切相关。2005 年前重度 RP 的发生率为 18.8%，2006 年后为 3.5%（p=0.042）。剂量体积直方图参数与这些重度 RP 患者之间无相关性。
SBRT 治疗前 CT 上有 IP 阴影和血清 KL-6 和 SP-D 值较高的患者发生重度放射性肺炎的发生率较高。2006 年后治疗患者的 RP 发生率降低可能归因于患者的预筛选。因此，建议在原发性或继发性肺肿瘤患者的管理和治疗中，在 SBRT 前对 CT 上的 IP 阴影和血清 KL-6 和 SP-D 进行预筛选。
