Department of Radiation Oncology, VU University Medical Center Amsterdam, The Netherlands.
J Thorac Oncol. 2012 Aug;7(8):1271-5. doi: 10.1097/JTO.0b013e3182582912.
Commonly reported complications after concurrent chemoradiotherapy (CCRT) in patients with stage III non-small-cell lung cancer (NSCLC) include febrile neutropenia, radiation esophagitis, and pneumonitis. We studied the incidence of tumor cavitation and/or "tumor abscess" after CCRT in a single-institutional cohort.
Between 2003 and 2010, 87 patients with stage III NSCLC underwent cisplatin-based CCRT and all subsequent follow-up at the VU University Medical Center. Diagnostic and radiotherapy planning computed tomography scans were reviewed for tumor cavitation, which was defined as a nonbronchial air-containing cavity located within the primary tumor. Pulmonary toxicities scored as Common Toxicity Criteria v3.0 of grade III or more, occurring within 90 days after end of radiotherapy, were analyzed.
In the entire cohort, tumor cavitation was observed on computed tomography scans of 16 patients (18%). The histology in cavitated tumors was squamous cell (n = 14), large cell (n = 1), or adenocarcinoma (n = 1). Twenty patients (23%) experienced pulmonary toxicity of grade III or more, other than radiation pneumonitis. Eight patients with a tumor cavitation (seven squamous cell carcinoma) developed severe pulmonary complications; tumor abscess (n = 5), fatal hemorrhage (n = 2), and fatal embolism (n = 1). Two patients with a tumor abscess required open-window thoracostomy post-CCRT. The median overall survival for patients with or without tumor cavitation were 9.9 and 16.3 months, respectively (p = 0.09).
With CCRT, acute pulmonary toxicity of grade III or more developed in 50% of patients with stage III NSCLC, who also had radiological features of tumor cavitation. The optimal treatment of patients with this presentation is unclear given the high risk of a tumor abscess.
在接受同步放化疗（CCRT）的 III 期非小细胞肺癌（NSCLC）患者中，常见的并发症包括发热性中性粒细胞减少症、放射性食管炎和肺炎。我们研究了单机构队列中 CCRT 后肿瘤空洞和/或“肿瘤脓肿”的发生率。
2003 年至 2010 年间，87 例 III 期 NSCLC 患者在 VU 大学医学中心接受顺铂为基础的 CCRT 治疗和所有后续随访。对诊断和放疗计划 CT 扫描进行了肿瘤空洞的回顾，定义为位于原发性肿瘤内的非支气管含气腔。分析了在放疗结束后 90 天内发生的 3.0 级或更高级别的、被归类为常见毒性标准的肺部毒性。
在整个队列中，16 例患者（18%）的 CT 扫描上观察到肿瘤空洞。空洞性肿瘤的组织学类型为鳞状细胞癌（n=14）、大细胞癌（n=1）或腺癌（n=1）。20 例（23%）患者发生 3 级或更高级别的肺部毒性，除外放射性肺炎。8 例肿瘤空洞（7 例鳞状细胞癌）患者发生严重肺部并发症；肿瘤脓肿（n=5）、致命性出血（n=2）和致命性栓塞（n=1）。2 例肿瘤脓肿患者在 CCRT 后需要开胸术。有或无肿瘤空洞的患者的中位总生存期分别为 9.9 个月和 16.3 个月（p=0.09）。
在接受 CCRT 的 III 期 NSCLC 患者中，50%发生 3 级或更高级别的急性肺部毒性，同时具有肿瘤空洞的影像学特征。鉴于肿瘤脓肿的高风险，这种表现患者的最佳治疗方法尚不清楚。
