Department of Radiotherapy, University Hospital Gasthuisberg, Leuven, Belgium.
Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):701-7. doi: 10.1016/j.ijrobp.2010.12.058. Epub 2011 Mar 11.
To evaluate the long-term impact of locoregional breast radiotherapy (RT) on pulmonary function tests (PFTs).
This study included 75 women who underwent postoperative locoregional breast RT. PFTs were performed before RT and 3, 6, and 12 months and 8 to 10 years after RT. By use of univariate and multivariate analyses, the impact of treatment- and patient-related factors on late changes in PFTs was evaluated.
During the first year after RT, all PFTs significantly worsened at 3 to 6 months after RT (p < 0.05). At 12 months, forced vital capacity (FVC), vital capacity (VC), and forced expiratory volume in 1 second (FEV(1)) recovered almost to baseline values, whereas total lung capacity (TLC) and diffusion capacity of carbon monoxide (DL(CO)) recovered only slightly and were still found to be decreased compared with baseline (p < 0.05). At 8 to 10 years after RT, mean reductions in FEV(1) of 4% (p = 0.03) and in VC, DL(CO), and TLC of 5%, 9%, and 11% (all p < 0.0001), respectively, were observed compared with pre-RT values. On multivariate analysis, tamoxifen use negatively affected TLC at 8 to 10 years after RT (p = 0.033), whereas right-sided irradiation was associated with a late reduction in FEV(1) (p = 0.027). For FEV(1) and DL(CO), an early decrease was predictive for a late decrease (p = 0.003 and p = 0.0009, respectively).
The time course of PFT changes after locoregional RT for breast cancer follows a biphasic pattern. An early reduction in PFTs at 3 to 6 months with a partial recovery at 12 months after RT is followed by a late, more important PFT reduction up to 8 to 10 years after RT. Tamoxifen use may have an impact on this late decline in PFTs.
评估局部区域乳腺癌放疗（RT）对肺功能测试（PFT）的长期影响。
本研究纳入了 75 例行术后局部区域乳腺癌 RT 的女性患者。PFT 在 RT 前以及 RT 后 3、6 和 12 个月以及 8 至 10 年内进行。通过单变量和多变量分析，评估了治疗和患者相关因素对 PFT 晚期变化的影响。
在 RT 后的第一年，所有 PFT 在 RT 后 3 至 6 个月时均显著恶化（p<0.05）。在 12 个月时，用力肺活量（FVC）、肺活量（VC）和 1 秒用力呼气量（FEV1）几乎恢复到基线值，而总肺容量（TLC）和一氧化碳弥散量（DLCO）仅略有恢复，与基线相比仍有下降（p<0.05）。在 RT 后 8 至 10 年内，与 RT 前相比，FEV1 平均下降 4%（p=0.03），VC、DLCO 和 TLC 分别下降 5%、9%和 11%（均 p<0.0001）。多变量分析显示，他莫昔芬的使用对 RT 后 8 至 10 年内的 TLC 有负面影响（p=0.033），而右侧照射与 FEV1 的晚期下降有关（p=0.027）。对于 FEV1 和 DLCO，早期下降预示着晚期下降（p=0.003 和 p=0.0009）。
乳腺癌局部区域 RT 后 PFT 变化的时间过程呈双相模式。RT 后 3 至 6 个月的早期 PFT 下降，RT 后 12 个月部分恢复，随后 RT 后 8 至 10 年内出现更重要的晚期 PFT 下降。他莫昔芬的使用可能对这种晚期 PFT 下降有影响。
