Suesada Milena Mako, Carvalho Heloisa de Andrade, Albuquerque André Luis Pereira de, Salge João Marcos, Stuart Silvia Radwanski, Takagaki Teresa Yae
. Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.
. Departamento de Radiologia e Oncologia / Radioterapia, Instituto de Radiologia - InRad -Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.
J Bras Pneumol. 2018 Nov-Dec;44(6):469-476. doi: 10.1590/S1806-37562017000000120.
To evaluate the impact of thoracic radiotherapy on respiratory function and exercise capacity in patients with breast cancer.
Breast cancer patients in whom thoracic radiotherapy was indicated after surgical treatment and chemotherapy were submitted to HRCT, respiratory evaluation, and exercise capacity evaluation before radiotherapy and at three months after treatment completion. Respiratory muscle strength testing, measurement of chest wall mobility, and complete pulmonary function testing were performed for respiratory evaluation; cardiopulmonary exercise testing was performed to evaluate exercise capacity. The total radiotherapy dose was 50.4 Gy (1.8 Gy/fraction) to the breast or chest wall, including supraclavicular lymph nodes (SCLN) or not. Dose-volume histograms were calculated for each patient with special attention to the ipsilateral lung volume receiving 25 Gy (V25), in absolute and relative values, and mean lung dose.
The study comprised 37 patients. After radiotherapy, significant decreases were observed in respiratory muscle strength, chest wall mobility, exercise capacity, and pulmonary function test results (p < 0.05). DLCO was unchanged. HRCT showed changes related to radiotherapy in 87% of the patients, which was more evident in the patients submitted to SCLN irradiation. V25% significantly correlated with radiation pneumonitis.
In our sample of patients with breast cancer, thoracic radiotherapy seemed to have caused significant losses in respiratory and exercise capacity, probably due to chest wall restriction; SCLN irradiation represented an additional risk factor for the development of radiation pneumonitis.
评估胸部放疗对乳腺癌患者呼吸功能和运动能力的影响。
接受手术治疗和化疗后需进行胸部放疗的乳腺癌患者，在放疗前及治疗结束后三个月接受高分辨率计算机断层扫描（HRCT）、呼吸功能评估和运动能力评估。呼吸功能评估包括呼吸肌力量测试、胸壁活动度测量和完整的肺功能测试；进行心肺运动测试以评估运动能力。对乳房或胸壁的总放疗剂量为50.4 Gy（1.8 Gy/分次），包括或不包括锁骨上淋巴结（SCLN）。计算每位患者的剂量体积直方图，特别关注接受25 Gy照射的同侧肺体积（V25）的绝对值和相对值以及平均肺剂量。
该研究纳入了37例患者。放疗后，呼吸肌力量、胸壁活动度、运动能力和肺功能测试结果均显著下降（p < 0.05）。一氧化碳弥散量（DLCO）未发生变化。HRCT显示87%的患者出现了与放疗相关的改变，在接受SCLN照射的患者中更为明显。V25%与放射性肺炎显著相关。
在我们的乳腺癌患者样本中，胸部放疗似乎导致了呼吸和运动能力的显著下降，可能是由于胸壁受限；SCLN照射是发生放射性肺炎的一个额外危险因素。
