Shapiro S J, Shapiro S D, Mill W B, Campbell E J
Mallinckrodt Institute of Radiology, Washington University School of Medicine, Radiation Oncology Center, MO 63110.
Int J Radiat Oncol Biol Phys. 1990 Sep;19(3):707-14. doi: 10.1016/0360-3016(90)90500-j.
Given the high cure rate of patients with Hodgkin's disease, the complications related to therapy take on great significance. Mantle irradiation to the thorax is used in virtually all patients with early stage Hodgkin's disease. Prior studies of patients receiving mantle irradiation demonstrated short-term (up to 24 months) abnormalities of pulmonary function. In the present study, we prospectively studied 13 patients for up to 60 months after irradiation only with serial pulmonary function tests, arterial blood gas tests, diffusing capacity of carbon monoxide, chest radiographs, and ventilation-perfusion scans. No respiratory symptoms attributable to therapy were noted. Frequent radiographic changes (62%) were found consisting of apical fibrosis, paramediastinal fibrosis, or pleural thickening. Two patients developed an asymptomatic spontaneous pneumothorax that resolved with conservative management. Ventilation-perfusion scans often (73%) revealed decreased perfusion to the lung apices with associated ventilatory deficits in one-half of these patients. Patients with intrathoracic disease had decreased lung volumes prior to therapy, and lung volumes did not change following irradiation. Lung mechanics were normal throughout the study. Gas exchange at rest was normal in patients with extrathoracic disease. Patients with intrathoracic disease often presented with an abnormal arterial PO2 and widened alveolar-arterial partial pressure gradient for oxygen. However, these parameters normalized by 9 months after therapy. Despite the frequent development of radiographic and V/Q scan abnormalities in the lung apices, patients tolerated mantle radiotherapy remarkably well. In fact, patients with intrathoracic disease demonstrated improved gas exchange at rest following therapy.
鉴于霍奇金病患者的治愈率较高，与治疗相关的并发症具有重要意义。几乎所有早期霍奇金病患者都采用胸部斗篷式照射。先前对接受斗篷式照射患者的研究表明，肺功能存在短期（长达24个月）异常。在本研究中，我们仅通过系列肺功能测试、动脉血气测试、一氧化碳弥散能力、胸部X线片和通气灌注扫描，对13例患者进行了长达60个月的前瞻性研究。未发现可归因于治疗的呼吸道症状。发现频繁的影像学改变（62%），包括肺尖纤维化、纵隔旁纤维化或胸膜增厚。2例患者出现无症状性自发性气胸，经保守治疗后好转。通气灌注扫描经常（73%）显示肺尖灌注减少，其中一半患者伴有通气功能障碍。胸内疾病患者在治疗前肺容量降低，照射后肺容量未改变。在整个研究过程中，肺力学正常。胸外疾病患者静息时气体交换正常。胸内疾病患者常出现动脉血氧分压异常和肺泡-动脉氧分压梯度增宽。然而，这些参数在治疗后9个月恢复正常。尽管肺尖频繁出现影像学和通气/灌注扫描异常，但患者对斗篷式放疗耐受性良好。事实上，胸内疾病患者治疗后静息时气体交换有所改善。
