Rosiello R A, Merrill W W
Department of Internal Medicine, Yale University Medical Center, New Haven, Connecticut.
Clin Chest Med. 1990 Mar;11(1):65-71.
The use of radiation therapy is limited by the occurrence of the potentially fatal clinical syndromes of radiation pneumonitis and fibrosis. Radiation pneumonitis usually becomes clinically apparent from 2 to 6 months after completion of radiation therapy. It is characterized by fever, cough, dyspnea, and alveolar infiltrates on chest roentgenogram and may be difficult to differentiate from infection or recurrent malignancy. The pathogenesis is uncertain, but appears to involve both direct lung tissue toxicity and an inflammatory response. The syndrome may resolve spontaneously or may progress to respiratory failure. Corticosteroids may be effective therapy if started early in the course of the disease. The time course for the development of radiation fibrosis is later than that for radiation pneumonitis. It is usually present by 1 year following irradiation, but may not become clinically apparent until 2 years after radiation therapy. It is characterized by the insidious onset of dyspnea on exertion. It most often is mild, but can progress to chronic respiratory failure. There is no known successful treatment for this condition.
放射治疗的应用受到放射性肺炎和纤维化这两种潜在致命临床综合征的限制。放射性肺炎通常在放射治疗结束后2至6个月出现临床症状。其特征为发热、咳嗽、呼吸困难，胸部X线片显示肺泡浸润，可能难以与感染或肿瘤复发相鉴别。其发病机制尚不清楚，但似乎涉及肺组织直接毒性和炎症反应。该综合征可能自行缓解，也可能进展为呼吸衰竭。如果在疾病早期开始使用，皮质类固醇可能是有效的治疗方法。放射性纤维化的发展时间比放射性肺炎晚。通常在照射后1年出现，但可能在放射治疗后2年才出现临床症状。其特征为运动时呼吸困难隐匿起病。多数情况下症状较轻，但可进展为慢性呼吸衰竭。目前尚无已知的有效治疗方法。
