Onishi Hiroshi, Marino Kan, Yamashita Hideomi, Terahara Atsuro, Onimaru Rikiya, Kokubo Masaki, Shioyama Yoshiyuki, Kozuka Takuyo, Matsuo Yukinori, Aruga Takashi, Hiraoka Masahiro
1 Department of Radiology, School of Medicine, University of Yamanashi, Yamanashi, Japan.
2 Department of Radiology, School of Medicine, University of Tokyo, Tokyo, Japan.
Technol Cancer Res Treat. 2018 Jan 1;17:1533033818801323. doi: 10.1177/1533033818801323.
The purpose of this study was to examine the characteristics and treatment plans of patients who experienced fatal radiation pneumonitis after stereotactic body radiation therapy for primary or oligometastatic lung cancer. Records of 1789 patients treated with stereotactic body radiation therapy for primary or oligometastatic lung cancer were retrospectively reviewed to identify those who developed fatal radiation pneumonitis. Twenty-three (1.3%; 18 men and 5 women) patients developed fatal radiation pneumonitis after stereotactic body radiation therapy for lung cancer; their median age was 74 years. The mean Krebs von den Lungen-6 level and percent vital capacity were 1320 U/mL and 82%, respectively. Prestereotactic body radiation therapy computed tomography revealed pulmonary interstitial change in 14 (73.7%) of 19 patients in whom computed tomography data could be reviewed. Seven (30.4%) of 23 patients had regularly used steroids. The median time duration between stereotactic body radiation therapy commencement and pneumonia symptom appearance was 75 (range: 14-204) days. Median survival time following pneumonia symptom appearance was 53 (range: 4-802) days. The 6- and 12-month overall survival rates were 34.8% and 13.0%, respectively. The 6-month overall survival rates in patients with and without heart disease were 50.0%, 16.7%, and 46.7% for heart disease existence, respectively. There were 4 patients in whom fatal radiation pneumonitis occurred within 2 months after stereotactic body radiation therapy and who died within 1 month. Three of them had no pulmonary interstitial change before stereotactic body radiation therapy, but had heart disease. In summary, the survival time in this case series was generally short but varied widely. More than half of the patients had pulmonary interstitial change before stereotactic body radiation therapy, although immediately progressive fatal radiation pneumonitis was also observed in patients without pulmonary interstitial change. True risk factors for fatal radiation pneumonitis should be examined in a prospective study with a larger cohort.
本研究的目的是探讨接受立体定向体部放射治疗的原发性或寡转移性肺癌患者发生致命性放射性肺炎的特征及治疗方案。对1789例接受立体定向体部放射治疗的原发性或寡转移性肺癌患者的记录进行回顾性分析，以确定发生致命性放射性肺炎的患者。23例（1.3%；18例男性和5例女性）患者在接受立体定向体部放射治疗肺癌后发生致命性放射性肺炎；他们的中位年龄为74岁。平均Krebs von den Lungen-6水平和肺活量百分比分别为1320 U/mL和82%。在19例可回顾计算机断层扫描数据的患者中，14例（73.7%）在立体定向体部放射治疗前的计算机断层扫描显示有肺间质改变。23例患者中有7例（30.4%）曾规律使用类固醇。从立体定向体部放射治疗开始到肺炎症状出现的中位时间为75天（范围：14 - 204天）。肺炎症状出现后的中位生存时间为53天（范围：4 - 802天）。6个月和12个月的总生存率分别为34.8%和13.0%。有心脏病和无心脏病患者的6个月总生存率分别为50.0%、16.7%和46.7%。有4例患者在立体定向体部放射治疗后2个月内发生致命性放射性肺炎，并在1个月内死亡。其中3例在立体定向体部放射治疗前无肺间质改变，但有心脏病。总之，本病例系列中的生存时间一般较短，但差异很大。超过一半的患者在立体定向体部放射治疗前有肺间质改变，尽管在无肺间质改变的患者中也观察到了立即进展的致命性放射性肺炎。应在前瞻性研究中纳入更大队列来研究致命性放射性肺炎的真正危险因素。
