Ono Takashi, Hareyama Masato, Nakamura Tatsuya, Kimura Kanako, Hayashi Yuichiro, Azami Yusuke, Hirose Katsumi, Hatayama Yoshiomi, Suzuki Motohisa, Wada Hitoshi, Kikuchi Yasuhiro, Nemoto Kenji
Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan.
Department of Radiation Oncology, Sapporo Teishinkai Hospital, 1-3-1, Kita33johigashi, Higashi, Sapporo, Hokkaido, Japan.
Radiat Oncol. 2016 Apr 18;11:56. doi: 10.1186/s13014-016-0637-3.
The purpose of this study is to retrospectively evaluate the incidence of lung toxicities after proton beam therapy (PBT) in patients with idiopathic pulmonary fibrosis (IPF).
Patients diagnosed with primary lung cancer or lung metastasis who were treated with PBT between January 2009 and May 2015 were recruited from our database retrospectively. Cases of pneumonitis (excluding infection-related pneumonitis) were evaluated using the Common Terminology Criteria for Adverse Events version 4.0, and the Fletcher-Hugh-Jones classification of respiratory status was used to evaluate pretreatment and posttreatment respiratory function.
Sixteen IPF patients received PBT for lung tumors, 15 received PBT for primary lung cancer, and one patient received PBT for metastasis from lung cancer. The cohort was composed of 14 men and 2 women, with a median age of 76 years (range: 63-89 years). The median follow-up time was 12 months (range: 4-39 months). The median dose of PBT was 80.0 Gy relative biological dose effectiveness (RBE) (range: 66.0-86.4 Gy [RBE]). The cumulative incidence of pneumonitis was 19.8 % (95 % confidence interval [CI]: 0-40.0 %), including one case of grade 5 pneumonitis. Reduced respiratory function was observed after PBT in seven patients, including one patient with pleural dissemination; five of these patients required home oxygen therapy.
This study suggests that PBT can be performed more safely in IPF patients than surgery or X-ray irradiation. Although PBT has become a treatment choice for lung tumors of patients with IPF, the adverse events warrant serious attention.
本研究的目的是回顾性评估特发性肺纤维化（IPF）患者接受质子束治疗（PBT）后肺部毒性的发生率。
从我们的数据库中回顾性招募2009年1月至2015年5月期间接受PBT治疗的原发性肺癌或肺转移癌患者。使用不良事件通用术语标准第4.0版评估肺炎病例（不包括感染相关性肺炎），并使用Fletcher-Hugh-Jones呼吸状态分类法评估治疗前和治疗后的呼吸功能。
16例IPF患者因肺部肿瘤接受PBT，15例因原发性肺癌接受PBT，1例因肺癌转移接受PBT。该队列由14名男性和2名女性组成，中位年龄为76岁（范围：63 - 89岁）。中位随访时间为12个月（范围：4 - 39个月）。PBT的中位剂量为80.0 Gy相对生物剂量效能（RBE）（范围：66.0 - 86.4 Gy [RBE]）。肺炎的累积发生率为19.8%（95%置信区间[CI]：0 - 40.0%），包括1例5级肺炎。7例患者在PBT后观察到呼吸功能下降，其中1例有胸膜播散；这些患者中有5例需要家庭氧疗。
本研究表明，与手术或X线照射相比，IPF患者接受PBT可能更安全。尽管PBT已成为IPF患者肺部肿瘤的一种治疗选择，但不良事件值得严重关注。
