Eom Jung Seop, Kim BoKyong, Kim Hojoong, Jeon Kyeongman, Um Sang-Won, Koh Won-Jung, Suh Gee Young, Chung Man Pyo, Kwon O Jung
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Respirology. 2014 Aug;19(6):914-20. doi: 10.1111/resp.12336. Epub 2014 Jun 17.
Radiotherapy is usually administered to the central airway in patients with unresectable adenoid cystic carcinoma (ACC). The purpose of this study was to describe the outcomes of endobronchial intervention in patients with airway stenosis following radiotherapy for ACC. Moreover, we investigated the incidence and contributing factors for airway stenosis following radiotherapy for ACC.
Forty-seven patients with ACC, who underwent radiotherapy of the tracheobronchial tree from January 1995 to December 2011, were reviewed retrospectively. Fibrotic airway stenoses were diagnosed using three-dimensional computed tomography, flexible bronchoscopy or both.
Eleven (23%) of the 47 patients with ACC suffered fibrotic airway stenosis following radiotherapy and received bronchoscopic intervention. The median interval from radiotherapy to diagnosis of fibrotic airway stenosis was 7 months. Low forced expiratory volume in 1 s (FEV1), FEV1 /forced vital capacity and brachytherapy were verified as factors contributing to radiotherapy-induced airway stenosis. Bronchoscopic intervention provided both symptomatic relief and improvement of lung function, and no procedure-related death or major complication was observed. Insertion of a straight silicone stent was required in 10 patients (91%), and 4 (36%) eventually received Y-shaped silicone stents. The stents, once implanted, could not be removed in any of the patients; stents were well-tolerated for a prolonged period in all patients.
Fibrotic airway stenosis following radiotherapy in patients with ACC is often found. Bronchoscopic intervention, including silicone airway stenting, was a safe and useful method for treating radiotherapy-induced fibrotic airway stenosis in patients with ACC.
对于不可切除的腺样囊性癌（ACC）患者，通常会对其中央气道进行放射治疗。本研究的目的是描述ACC放疗后气道狭窄患者的支气管内介入治疗结果。此外，我们还调查了ACC放疗后气道狭窄的发生率及相关因素。
回顾性分析了1995年1月至2011年12月期间接受气管支气管树放射治疗的47例ACC患者。通过三维计算机断层扫描、可弯曲支气管镜检查或两者结合诊断纤维化气道狭窄。
47例ACC患者中有11例（23%）在放疗后出现纤维化气道狭窄并接受了支气管镜介入治疗。从放疗到诊断为纤维化气道狭窄的中位间隔时间为7个月。一秒用力呼气容积（FEV1）降低、FEV1/用力肺活量降低以及近距离放射治疗被证实是放疗引起气道狭窄的相关因素。支气管镜介入治疗缓解了症状并改善了肺功能，未观察到与手术相关的死亡或严重并发症。10例患者（91%）需要插入直硅胶支架，4例（36%）最终接受了Y形硅胶支架。所有患者植入的支架均无法取出；所有患者对支架的耐受性良好，可长期使用。
ACC患者放疗后常出现纤维化气道狭窄。支气管镜介入治疗，包括硅胶气道支架置入，是治疗ACC患者放疗引起的纤维化气道狭窄的一种安全有效的方法。
