Veshler Z, Slavin Sh
Gematol Transfuziol. 1991 Jan;36(1):21-3.
Interstitial pneumonitis is one of the most serious complications in patients after bone marrow transplantation, and irradiation plays the main role in its etiology. A total of 44 patients with blood diseases were subjected to total-body irradiation before bone marrow transplantation. Chemotherapy, cyclophosphamide in a dose of 60 mg/kg/day, was conducted during two successive days. Group I patients (n-23) were subjected to irradiation in a total dose of 12 Gy used as 6 fractions of 2 Gy twice a day, during 3 successive days. Group II patients, after irradiation with 6 Gy, were protected with lung shields that inhibited 50% of irradiation thus reducing the irradiation dose in the area of the lung up to 9 Gy. Then the patients received a total dose of 6 Gy during two days. Radiation pneumonitis developed in 6 out of 23 patients, 3 of them died. No non-infectious complications of the lungs were observed in group II patients with partial protection of the lung tissue. The data obtained have evidenced that thoroughly developed radiotherapeutic program with a special attention to the prevention of excessive irradiation of the lung tissue can reduce incidence of radiation pneumonitis in patients after bone marrow transplantation.
间质性肺炎是骨髓移植患者最严重的并发症之一，放疗在其病因中起主要作用。共有44例血液病患者在骨髓移植前接受了全身照射。化疗采用环磷酰胺，剂量为60mg/kg/天，连续进行两天。第一组患者（n = 23）接受了总量为12Gy的照射，分6次，每次2Gy，每天两次，连续照射3天。第二组患者在接受6Gy照射后，使用肺屏蔽进行保护，该屏蔽可抑制50%的照射，从而将肺部区域的照射剂量降低至9Gy。然后患者在两天内接受了总量为6Gy的照射。23例患者中有6例发生放射性肺炎，其中3例死亡。在肺部组织得到部分保护的第二组患者中未观察到肺部的非感染性并发症。所获得的数据证明，精心制定的放疗方案，特别注意预防肺部组织过度照射，可降低骨髓移植患者放射性肺炎的发生率。
