Department of Radiology, Ofuna Chuo Hospital, Tokyo, Japan; Department of Radiology, Tokyo Metropolitan Hiroo General Hospital, Tokyo, Japan.
Department of Radiation Oncology, Tokai University Kanagawa, Tokyo, Japan.
Chest. 2012 Apr;141(4):858-866. doi: 10.1378/chest.11-1193. Epub 2011 Sep 1.
The primary cause of COPD and lung cancer is smoking. Thus, patients with COPD frequently have lung cancer that often is inoperable. Stereotactic body radiation therapy (SBRT) is anticipated to be the standard of care for inoperable early stage non-small cell lung cancer. The most critical toxicity following SBRT is radiation pneumonitis (RP). We analyzed predictive factors for RP following SBRT and investigated the degree and occurrence of RP in patients with severe COPD.
We retrospectively evaluated 265 lung tumors treated with SBRT between 2005 and 2010 with a minimum follow-up of 6 months. Predictive factors for RP, including GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage and pack-years smoked, were evaluated by univariate and multivariate analyses. RP was graded according to the Common Terminology Criteria for Adverse Events version 3.0 scale.
Median follow-up was 19.2 months (range, 6.0-72.0 months). RP grades of 0, 1, 2, 3, 4, and 5 occurred in 101, 102, 49, 12, 0, and one of these patients, respectively. Multivariate analysis revealed that high normal lung volume receiving ≥ 20 Gy, fewer pack-years smoked, and high total dose were significant predictive factors for RP ≥ grade 1, and high normal lung volume receiving 20 Gy, fewer pack-years smoked, and a history of lung resection were predictive for RP ≥ grade 2. RP in patients with more severe COPD was relatively milder than in patients with normal lung function and with mild COPD. Pack-year scales were significantly correlated with GOLD stage.
RP following SBRT in patients with severe COPD was relatively mild. Heavy smoking was the strongest negative predictor for severe RP and was correlated with severe COPD. Further follow-up and quantitative analysis of lung function might be needed to ascertain longer tolerability to SBRT.
COPD 和肺癌的主要病因是吸烟。因此，COPD 患者常患有肺癌，且往往无法手术。立体定向体部放射治疗（SBRT）有望成为不可手术的早期非小细胞肺癌的标准治疗方法。SBRT 后最关键的毒性反应是放射性肺炎（RP）。我们分析了 SBRT 后 RP 的预测因素，并研究了重度 COPD 患者 RP 的程度和发生情况。
我们回顾性评估了 2005 年至 2010 年间接受 SBRT 治疗的 265 个肺部肿瘤，随访时间至少为 6 个月。通过单因素和多因素分析评估了 RP 的预测因素，包括 GOLD（全球慢性阻塞性肺疾病倡议）分期和吸烟包年数。RP 按通用不良事件术语标准 3.0 量表分级。
中位随访时间为 19.2 个月（范围：6.0-72.0 个月）。0、1、2、3、4 和 5 级 RP 分别发生在 101、102、49、12、0 和 1 例患者中。多因素分析显示，高正常肺体积接受≥20Gy、吸烟包年数少和总剂量高是 RP≥1 级的显著预测因素，高正常肺体积接受 20Gy、吸烟包年数少和肺切除术史是 RP≥2 级的预测因素。重度 COPD 患者的 RP 相对较轻，与正常肺功能和轻度 COPD 患者相比。吸烟包年数与 GOLD 分期显著相关。
SBRT 后重度 COPD 患者的 RP 相对较轻。重度吸烟是严重 RP 的最强负预测因素，与重度 COPD 相关。可能需要进一步随访和肺功能定量分析以确定对 SBRT 的更长耐受性。
