Guo Leiming, Ding Gaofeng, Xu Wencai, Lu Yufei, Ge Hong, Jiang Yue, Chen Xijuan, Li Yin
Department of Radiotherapy, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Zhengzhou, Henan 450000, P.R. China.
Exp Ther Med. 2019 Jan;17(1):244-250. doi: 10.3892/etm.2018.6936. Epub 2018 Nov 6.
Radiation pneumonitis (RP) is one of the most common dose-limiting toxicity syndromes in patients with thoracic malignant tumors receiving radiotherapy. The present study aimed to identify biological factors for the prediction of RP. Pulmonary perfusion imaging is capable of reflecting the differential functional activity of various regions of the lung, and in the present study, radiotherapy plans that were established on the basis that pulmonary perfusion images have high biological conformality, which may identify regions vulnerable to RP to spare them from radiation. A total of 46 patients with non-small cell lung cancer (NSCLC), exhibiting high and low levels of apurinic/apyrimidinic endonuclease-1 (Ape-1), intercellular adhesion molecule (ICAM)-1 and interleukin (IL)-17A prior to treatment, with SBRT with respective cut-off values of 4.2, 3.0 and 5.1 µg/l were stratified into groups A and B. Patients received radiation doses within the margin of the planning target volume. Stereotactic body radiation therapy (SBRT) was used for the treatment of NSCLC and single-photon emission computed tomography pulmonary perfusion imaging was used to assess all patients for the presence of RP. Furthermore, the serum levels of Ape-1, ICAM-1 and IL-17A were examined by ELISA. Prior to SBRT, perfusion images indicated that no RP was present in any of the patients, and 23 patients had high levels of Ape-1, ICAM-1 and IL-17A. After SBRT, 22 out of 23 patients in group A (95.65%) presented with RP and 1 patient (4.35%) had no RP. In group B, 6 out of 23 patients (26.09%) had RP and 17 patients (73.91%) had no RP after SBRT. The difference between the two groups in the incidence of RP was significant (P=1.66×10 <0.05). In conclusion, high levels of Ape-1, ICAM-1 and IL-17A are associated with an increased risk of RP. A further analysis should be performed in the future to verify whether these factors have significant prognostic value.
放射性肺炎（RP）是接受放疗的胸部恶性肿瘤患者中最常见的剂量限制性毒性综合征之一。本研究旨在确定预测RP的生物学因素。肺灌注成像能够反映肺各个区域不同的功能活性，在本研究中，基于肺灌注图像具有高生物学适形性来制定放疗计划，这可能识别出易患RP的区域，使其免受辐射。共有46例非小细胞肺癌（NSCLC）患者，治疗前血清中脱嘌呤/脱嘧啶内切酶-1（Ape-1）、细胞间黏附分子（ICAM）-1和白细胞介素（IL）-17A水平高低不同，将SBRT分割值分别为4.2、3.0和5.1μg/l的患者分为A组和B组。患者接受计划靶体积边缘内的放射剂量。采用立体定向体部放射治疗（SBRT）治疗NSCLC，并使用单光子发射计算机断层扫描肺灌注成像评估所有患者是否发生RP。此外，通过酶联免疫吸附测定（ELISA）检测Ape-1、ICAM-1和IL-17A的血清水平。在SBRT前，灌注图像显示所有患者均未发生RP，23例患者Ape-1、ICAM-1和IL-17A水平较高。SBRT后，A组23例患者中有22例（95.65%）发生RP，1例（4.35%）未发生RP。B组23例患者中有6例（26.09%）发生RP，17例（73.91%）未发生RP。两组RP发生率差异有统计学意义（P=1.66×10＜0.05）。总之，Ape-1、ICAM-1和IL-17A水平升高与RP风险增加相关。未来应进一步分析以验证这些因素是否具有显著的预后价值。
