Ferrero Cinzia, Badellino Serena, Filippi Andrea Riccardo, Focaraccio Luana, Giaj Levra Matteo, Levis Mario, Moretto Francesco, Torchio Roberto, Ricardi Umberto, Novello Silvia
Respiratory Function and Sleep Laboratory, S. Luigi Hospital, Orbassano, Italy.
Department of Oncology, University of Torino, Torino, Italy.
Lung Cancer. 2015 Sep;89(3):350-6. doi: 10.1016/j.lungcan.2015.06.019. Epub 2015 Jun 26.
To analyze changes in pulmonary function and quality of life (QoL) at different time points after Stereotactic Ablative Radiotherapy (SABR) for early stage inoperable lung cancer, and potential correlations between radiation dose-volume parameters and pulmonary toxicity or changes in pulmonary function tests (PFT) and QoL.
From July 2012 to October 2013, 30 patients were enrolled in this prospective observational study. Complete PFT were performed and Lung Cancer Symptoms Scale (LCSS) questionnaire administered prior to SABR; all patients then underwent Computed Tomography (CT) scan and PFT at 45, 135, 225 and 315 days after SABR, together with LCSS questionnaire. Clinical lung toxicity and radiological toxicity (acute and late) were prospectively recorded by using the Radiation Therapy Oncology Group (RTOG) scoring system.
A decline in Slow Vital Capacity (SVC), Forced Expiratory Volume in 1s (FEV1), Single-breath lung diffusing capacity (DLCO) and blood partial pressure of oxygen (PaO2) was seen at 135 days post-SABR. PaO2 values rescued to normal levels at 315 days. None of the baseline PFT parameters resulted to be associated with the occurrence of pulmonary toxicity or with late radiological changes. Mean V5, V10, and V20 and MLD2Gy were higher in patients who developed radiation pneumonitis, even if not significantly associated at Cox regression analysis. LCSS QoL showed a significant worsening of the single item fatigue at 135 days after SABR.
A small (mean 10%) but significant decline in lung volumes and DLCO was recorded after SABR, with clinical impact of such change difficult to estimate in individual patients. Global QoL was not significantly impaired. Dose-volume parameters did not emerge as significantly predictive of any clinical, radiological or functional toxicity.
分析立体定向消融放疗（SABR）治疗早期不可手术肺癌后不同时间点的肺功能和生活质量（QoL）变化，以及放射剂量 - 体积参数与肺毒性、肺功能测试（PFT）变化和QoL之间的潜在相关性。
2012年7月至2013年10月，30例患者纳入这项前瞻性观察研究。在SABR之前进行完整的PFT并发放肺癌症状量表（LCSS）问卷；所有患者在SABR后45、135、225和315天接受计算机断层扫描（CT）和PFT，同时发放LCSS问卷。使用放射肿瘤学组（RTOG）评分系统前瞻性记录临床肺毒性和放射学毒性（急性和晚期）。
SABR后135天，慢肺活量（SVC）、第1秒用力呼气量（FEV1）、单次呼吸肺弥散量（DLCO）和血氧分压（PaO2）下降。PaO2值在315天时恢复到正常水平。基线PFT参数均与肺毒性的发生或晚期放射学变化无关。发生放射性肺炎的患者平均V5、V10和V20以及MLD2Gy较高，即使在Cox回归分析中无显著相关性。LCSS QoL显示SABR后135天单项疲劳显著恶化。
SABR后记录到肺容积和DLCO有小幅度（平均10%）但显著的下降，这种变化对个体患者的临床影响难以估计。整体QoL未受到显著损害。剂量 - 体积参数未显示出对任何临床、放射学或功能毒性有显著预测性。
