Tokunaga Yoshimasa, Tarumi Shintaro, Yokomise Hiroyasu
Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Kagawa University, Kagawa, Japan.
Kyobu Geka. 2016 Jan;69(1):47-52.
Chemoradiotherapy for non-small cell lung cancer (NSCLC) can impair pulmonary function, particularly when it is followed by surgery. This study aimed to document the changes in respiratory function as a result of a perioperative intensive pulmonary rehabilitation program in patients with NSCLC who underwent induction chemoradiotherapy.
A total of 82 consecutive patients underwent pulmonary resection after undergoing induction chemoradiotherapy. A pulmonary rehabilitation program was started at the same time as the induction chemoradiotherapy. Standard respiratory function tests were performed before and after induction chemoradiotherapy. Treatment-related mortality and the incidence of postoperative respiratory complications were investigated. The Wilcoxon signed-rank test was used to analyze the differences in spirometric changes.
All patients underwent a pulmonary rehabilitation program for an average of 10 weeks. Significant increases were observed in forced vital capacity (FVC) [+6.4%, p=.0096] and forced expiratory volume in 1 second( FEV(1))[ +10.4%, p<.0001]. Diffusing capacity of the lung for carbon monoxide decreased(-14.0%, p<.0001). Patients with respiratory impairment (FVC <80% predicted or FEV(1)/FVCp<70%) showed significant improvements in FVC( +13.9%, p=.0025) and FEV(1)( +22.5%, p<.0001). Significant increases were observed in FVC( +7.0%, p=.0042) and FEV(1)( +10.8%, p<.0001) in patients with a smoking history. There was no mortality, and postoperative respiratory morbidity was 6.1%.
非小细胞肺癌（NSCLC）的放化疗会损害肺功能，尤其是在放化疗后进行手术时。本研究旨在记录接受诱导放化疗的NSCLC患者围手术期强化肺康复计划后呼吸功能的变化。
共有82例连续患者在接受诱导放化疗后接受了肺切除术。肺康复计划在诱导放化疗同时开始。在诱导放化疗前后进行标准呼吸功能测试。调查治疗相关死亡率和术后呼吸并发症的发生率。采用Wilcoxon符号秩检验分析肺量计变化的差异。
所有患者平均接受了10周的肺康复计划。观察到用力肺活量（FVC）显著增加[+6.4%，p=0.0096]，1秒用力呼气量（FEV₁）显著增加[+10.4%，p<0.0001]。肺一氧化碳弥散量下降（-14.0%，p<0.0001）。呼吸功能受损（FVC<预测值的80%或FEV₁/FVC<70%）的患者FVC有显著改善（+13.9%，p=0.0025），FEV₁有显著改善（+22.5%，p<0.0001）。有吸烟史的患者FVC显著增加（+7.0%，p=0.0042），FEV₁显著增加（+10.8%，p<0.0001）。无死亡病例，术后呼吸并发症发生率为6.1%。
