Bjermer L, Franzén L, Littbrand B, Nilsson K, Angström T, Henriksson R
Department of Oncology, Lung Medicine and Pathology, University Hospital, Umeå, Sweden.
Cancer Res. 1990 Apr 1;50(7):2027-30.
Quantitative measurements of the effects of irradiation on normal tissues in humans have been hard to obtain because most tissues are inaccessible and/or direct responses are difficult to quantify in a nondestructive manner. Pneumonitis and fibrotic lung disease are adverse effects seen in varying intensity in patients treated with radiotherapy for carcinomas of the thorax, e.g., breast cancer. In the present study the aim was to evaluate the inflammatory reaction in the underlying parenchyma following postoperative irradiation with bronchoalveolar lavage technique. Twenty-one patients (11 smokers, 10 nonsmokers) with breast cancer stage T1N0M0 received radiotherapy with photons to a target dose of 56 Gy following breast conservative surgery. Nineteen healthy controls were also included. The results showed a clear elevation of neutrophils, mast cells, eosinophils, and lymphocytes in the total irradiated groups, compared to controls. When subclassifying the material according to smoking habit, it was obvious that the smokers displayed a significantly decreased inflammatory reaction, i.e., reduced levels of mast cells and lymphocytes, compared to both nonsmoking controls and patients. Eosinophils were seen in an elevated number in all irradiated patients. Radiological signs of pneumonitis were observed in three patients, all in the nonsmoking group. No correlation was found between the volume of lung irradiated and the inflammatory response. It is concluded that bronchoalveolar lavage is a suitable and sensitive method for investigating radiotherapy-induced reactions in the human lung. Furthermore, ongoing smoking during the treatment depressed the inflammatory response in the lung parenchyma induced by irradiation. The present study as well as earlier observations justify further studies concerning the possibility of interaction of smoking with cancer treatment, both from the view of therapeutic failures and reduced adverse effects.
由于大多数组织难以触及，且/或难以以非破坏性方式对直接反应进行量化，因此很难获得关于辐射对人体正常组织影响的定量测量结果。肺炎和肺纤维化疾病是胸部癌症（如乳腺癌）放疗患者中出现的不同程度的不良反应。在本研究中，目的是采用支气管肺泡灌洗技术评估术后放疗后肺实质中的炎症反应。21例T1N0M0期乳腺癌患者（11例吸烟者，10例非吸烟者）在保乳手术后接受了光子放疗，靶剂量为56 Gy。还纳入了19名健康对照者。结果显示，与对照组相比，整个放疗组的中性粒细胞、肥大细胞、嗜酸性粒细胞和淋巴细胞明显升高。根据吸烟习惯对材料进行分类时，很明显，与非吸烟对照者和患者相比，吸烟者的炎症反应明显降低，即肥大细胞和淋巴细胞水平降低。在所有接受放疗的患者中，嗜酸性粒细胞数量均升高。3例患者出现了肺炎的放射学征象，均在非吸烟组。未发现照射肺体积与炎症反应之间存在相关性。结论是，支气管肺泡灌洗是研究放疗引起的人肺反应的一种合适且敏感的方法。此外，治疗期间持续吸烟会抑制放疗诱导的肺实质炎症反应。本研究以及早期观察结果证明，从治疗失败和减少不良反应的角度来看，有必要进一步研究吸烟与癌症治疗相互作用的可能性。
