*Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan; †Department of Genome Biology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan; ‡Departments of Respiratory Medicine, and §Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; and ‖Department of Therapeutic Radiology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
J Thorac Oncol. 2015 Jan;10(1):116-25. doi: 10.1097/JTO.0000000000000359.
To investigate the impact of pre-existing radiological interstitial lung disease (ILD) findings on the incidence of radiation pneumonitis (RP) and clinical outcomes after stereotactic body radiation therapy (SBRT) for stage I non-small-cell lung cancer.
We included 157 consecutive patients who underwent SBRT alone for stage I non-small-cell lung cancer and whose pretreatment lung computed tomography images were available for retrospective review. The pretreatment computed tomography images were evaluated retrospectively for the presence of ILD. The incidence of RP, overall survival (OS) rate, and the incidence of disease progression and local progression were evaluated between patients with ILD (ILD[+]) and without ILD (ILD[-]).
Pre-existing ILD was identified in 20 patients. The median follow-up period was 39.5 months. The incidences of RP worse than grade 2 (≥ Gr2 RP) and worse than grade 3 (≥ Gr3 RP) were significantly higher in ILD(+) than ILD(-) (1 year ≥ Gr2 RP rate, 55.0% versus 13.3%; p < 0.001 and 1year ≥ Gr3 RP rate 10.0% versus 1.5%; p = 0.020). Multivariate analysis also indicated that ILD(+) was a risk factor for ≥ Gr2 and ≥ Gr3 RP, and the volume of the irradiated lung. The OS rate tended to be worse in ILD(+) than ILD(-) (3-year OS, 53.8% versus 70.8%; p = 0.28). No difference was observed in the disease progression or local progression rates.
Pre-existing ILD was a significant risk factor for symptomatic and severe RP. Prescreening for ILD findings is important for determining the radiation pneumonitis risk when planning SBRT.
研究预先存在的放射学间质性肺病（ILD）发现对立体定向体部放射治疗（SBRT）治疗 I 期非小细胞肺癌后放射性肺炎（RP）发生率和临床结局的影响。
我们纳入了 157 例连续接受单纯 SBRT 治疗的 I 期非小细胞肺癌患者，这些患者的治疗前肺部 CT 图像可用于回顾性复查。回顾性评估治疗前 CT 图像中是否存在ILD。评估ILD（ILD[+]）和无ILD（ILD[-]）患者的 RP 发生率、总生存率（OS）率、疾病进展和局部进展发生率。
20 例患者存在预先存在的ILD。中位随访时间为 39.5 个月。ILD（+）组的≥2 级（≥Gr2 RP）和≥3 级（≥Gr3 RP）RP 发生率明显高于ILD（-）组（1 年≥Gr2 RP 发生率，55.0%比 13.3%；p<0.001；1 年≥Gr3 RP 发生率，10.0%比 1.5%；p=0.020）。多变量分析还表明，ILD（+）是≥Gr2 和≥Gr3 RP 的危险因素，以及照射肺的体积。ILD（+）组的 OS 率较ILD（-）组有下降趋势（3 年 OS，53.8%比 70.8%；p=0.28）。疾病进展或局部进展率无差异。
预先存在的ILD 是发生症状性和严重 RP 的显著危险因素。在计划 SBRT 时，预先筛查ILD 发现对于确定放射性肺炎风险很重要。
