Department of Radiology, Kagawa University, Faculty of Medicine, Kagawa, Japan.
Br J Radiol. 2012 Feb;85(1010):135-41. doi: 10.1259/bjr/32629867. Epub 2011 Mar 8.
To evaluate the impact of pulmonary emphysema (PE) on the incidence and severity of radiation pneumonitis (RP) in patients with lung and mediastinal tumours.
92 patients were enrolled. Involved-field radiation therapy (non-small cell carcinoma or mediastinal tumours in 69 patients; median 70 Gy) and accelerated hyperfractionation (limited disease small cell carcinoma in 23 patients; median 45 Gy) were performed. Common Terminology Criteria for Adverse Events v.3.0 was used to evaluate RP and the relationship with the percentage of pulmonary volume irradiated to >20 Gy (V20) and PE. PE was diagnosed by the presence of low-attenuation areas (LAAs) on CT scans and was classified into Grades 0-4 according to the extent of the LAAs.
The median follow-up time was 16 months. The 6-month cumulative incidence of RP at Grade 3 or greater was 7.7% and 34.1% in patients with a V20 of <25% and ≥25%, respectively (p=0.017). In patients with PE Grades 0, 1, 2 and 3 or greater, the incidence of RP was 16.5%, 9.1%, 8.6% and 54.0%, respectively. As the PE Grade increased, the incidence of RP also increased significantly.
The incidence and severity of RP are significantly higher in patients with a high V20 value as well as in those with severe PE.
评估肺气肿（PE）对肺部和纵隔肿瘤患者放射性肺炎（RP）发生率和严重程度的影响。
共纳入 92 例患者。行累及野放疗（非小细胞癌或纵隔肿瘤患者 69 例；中位剂量 70 Gy）和加速超分割放疗（局限期小细胞癌患者 23 例；中位剂量 45 Gy）。采用不良事件通用术语标准 v.3.0 评估 RP，并分析其与肺部受照 20 Gy 以上体积百分比（V20）和 PE 的关系。PE 通过 CT 扫描上低衰减区（LAAs）的存在进行诊断，并根据 LAAs 的范围分为 0-4 级。
中位随访时间为 16 个月。V20<25%和≥25%的患者 6 个月时 RP 发生率≥3 级的累积发生率分别为 7.7%和 34.1%（p=0.017）。PE 0、1、2 和 3 级或更高级别的患者 RP 发生率分别为 16.5%、9.1%、8.6%和 54.0%。随着 PE 分级的增加，RP 的发生率也显著增加。
V20 值较高和存在严重 PE 的患者，RP 的发生率和严重程度显著更高。
