Kasymjanova G, Jagoe R T, Pepe C, Sakr L, Cohen V, Small D, Muanza T M, Agulnik J S
Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC.
Radiation Oncology, Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC.
Curr Oncol. 2018 Dec;25(6):e610-e614. doi: 10.3747/co.25.4093. Epub 2018 Dec 1.
Radiotherapy (rt) plays an important role in the treatment of lung cancer. One of the most common comorbidities in patients with lung cancer is pulmonary emphysema. The literature offers conflicting data about whether emphysema increases the occurrence and severity of radiation pneumonitis (rp). As a result, whether high doses of rt (with curative intent) should be avoided in patients with emphysema is still unclear.
We measured the documented incidence of rp in patients with and without emphysema who received curative radiation treatment.
This retrospective cohort study considered patients in the lung cancer clinical database of the Peter Brojde Lung Cancer Centre. Data from the database has been used previously for research studies, including a recent publication about emphysema grading, based on the percentage of lung occupied by emphysema on computed tomography (ct) imaging.
Using previously published methods, chest ct imaging for 498 patients with lung cancer was scored for the presence of emphysema. The analysis considered 114 patients who received at least 30 Gy radiation. Of those 114 patients, 64 (56%) had emphysema, with approximately 23% having severe or very severe disease. The incidence of rp was 34.4% in patients with emphysema ( = 22) and 32.0% in patients with no emphysema ( = 16, = 0.48). No difference in the incidence of rp was evident between patients with various grades of emphysema ( = 0.96). Similarly, no difference in the incidence of rp was evident between the two treatment protocols-that is, definitive rt 17 (37%) and combined chemotherapy-rt 21 (31%, = 0.5).
In our cohort, the presence of emphysema on chest ct imaging was not associated with an increased risk of rp. That finding suggests that patients with lung cancer and emphysema should be offered rt when clinically indicated. However, further prospective studies will be needed for confirmation.
放射治疗（RT）在肺癌治疗中发挥着重要作用。肺癌患者最常见的合并症之一是肺气肿。关于肺气肿是否会增加放射性肺炎（RP）的发生率和严重程度，文献提供的数据相互矛盾。因此，肺气肿患者是否应避免高剂量RT（根治性目的）仍不明确。
我们测量了接受根治性放射治疗的有和没有肺气肿患者中记录的RP发生率。
这项回顾性队列研究纳入了彼得·布罗德耶肺癌中心肺癌临床数据库中的患者。该数据库的数据此前已用于研究，包括最近一篇关于肺气肿分级的出版物，分级基于计算机断层扫描（CT）成像上肺气肿占据肺的百分比。
采用先前发表的方法，对498例肺癌患者的胸部CT成像进行肺气肿存在情况评分。分析纳入了114例接受至少30 Gy放射治疗的患者。在这114例患者中，64例（56%）有肺气肿，约23%患有重度或极重度疾病。肺气肿患者的RP发生率为34.4%（n = 22），无肺气肿患者的RP发生率为32.0%（n = 16，P = 0.48）。不同等级肺气肿患者的RP发生率无明显差异（P = 0.96）。同样，两种治疗方案（即根治性RT 17例[37%]和化疗联合RT 21例[31%]，P = 0.5）的RP发生率也无明显差异。
在我们的队列中，胸部CT成像上肺气肿的存在与RP风险增加无关。这一发现表明，肺癌合并肺气肿患者在临床指征明确时应接受RT。然而，需要进一步的前瞻性研究来证实。
