Omarini Claudia, Thanopoulou Eirini, Johnston Stephen R D
Department of Medicine, Royal Marsden NHS Foundation Trust, Fulham Road, Chelsea, London, SW3 6JJ, UK,
Breast Cancer Res Treat. 2014 Jul;146(2):245-58. doi: 10.1007/s10549-014-3016-5. Epub 2014 Jun 15.
To review the available published data regarding the incidence, mechanisms of pathogenesis, clinical presentations and management of pneumonitis caused by anti-cancer treatments (radiotherapy (RT) and systemic agents) that are included in the guidelines of the treatment of breast cancer (BC) and address the issues on the current grading classification of pneumonitis. A literature search was performed between July and October 2013 using PubMed for papers published from January 1989 to October 2013. Any clinical trial, case report, case series, meta-analysis or systematic review that reported on pulmonary toxicity of any BC therapeutic modality was included (only papers published in English). Most of anticancer treatments currently used in the management of BC may induce some degree of pneumonitis that is estimated to have an incidence of 1-3 %. There is an obvious distinction between chemotherapy- and targeted treatment-related lung toxicity. Moreover, the current classification of pneumonitis needs to be modified as there is a clear diversity in grade 2. As pneumonitis is relatively common and reported as side effect of new anticancer agents, physicians need to be aware of the clinical and radiological manifestations of drug- and RT-induced toxicities in patients with BC. A key recommendation is the subdivision of grade 2 cases to two subgroups. We provide an algorithm, along with real life cases as managed in the breast Unit of Royal Marsden Hospital, with the aim to guide physicians in managing all possible eventualities that may come across in clinical practise.
回顾已发表的关于乳腺癌（BC）治疗指南中包含的抗癌治疗（放疗（RT）和全身用药）所致肺炎的发病率、发病机制、临床表现及管理的数据，并探讨当前肺炎分级分类的相关问题。2013年7月至10月期间，使用PubMed对1989年1月至2013年10月发表的论文进行了文献检索。纳入任何报道BC治疗方式肺部毒性的临床试验、病例报告、病例系列、荟萃分析或系统评价（仅英文发表的论文）。目前用于BC治疗的大多数抗癌治疗可能会诱发一定程度的肺炎，据估计其发病率为1%-3%。化疗相关和靶向治疗相关的肺部毒性存在明显区别。此外，由于2级存在明显差异，当前的肺炎分类需要修改。由于肺炎相对常见且被报道为新型抗癌药物的副作用，医生需要了解BC患者药物和放疗所致毒性的临床和影像学表现。一项关键建议是将2级病例细分为两个亚组。我们提供了一种算法，以及皇家马斯登医院乳腺科实际处理的病例，旨在指导医生处理临床实践中可能遇到的所有情况。
