Department of Radiation Oncology, MAASTRO Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
Department of Radiation Oncology, MAASTRO Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
Radiother Oncol. 2021 Feb;155:269-277. doi: 10.1016/j.radonc.2020.11.020. Epub 2020 Nov 24.
Idiopathic pulmonary fibrosis (IPF) is a progressive, fibrotic lung disease with an unknown cause. Uncertainties still remain regarding the pathogenesis of IPF, and the prognosis of this disease is poor despite some recent improvements in treatment. Radiation induced lung injury (RILI) is a common complication and a dose-limiting toxicity of thoracic radiotherapy. Importantly, IPF is a crucial risk factor for pulmonary toxicity after thoracic radiotherapy. Although IPF is not universally accepted as a definite contraindication for thoracic radiotherapy at present, it has been shown that IPF can increase the risk of severe and fatal complications after thoracic radiotherapy. Proton beam therapy has shown promising results in reducing the incidence of thoracic radiotherapy related life-threatening complications in IPF patients, but the current evidence is not sufficient to recommend the standard use of it. Many similarities are noticeable between IPF and RILI in terms of pathogenesis and underlying mechanisms. Better understanding of the mechanisms of IPF and RILI may enable clinicians to provide safer and more effective thoracic radiotherapy treatments in cancer patients with IPF. In this review, we summarize the current knowledge of IPF, present the importance of IPF in radiation oncology practice, and highlight the similarities and relationship between IPF and RILI.
特发性肺纤维化（IPF）是一种病因不明的进行性肺纤维化疾病。尽管最近在治疗方面有所改善，但 IPF 的发病机制仍存在不确定性，其预后较差。放射性肺损伤（RILI）是胸部放疗的常见并发症和剂量限制毒性。重要的是，IPF 是胸部放疗后发生肺毒性的关键危险因素。尽管目前普遍认为 IPF 不是胸部放疗的明确禁忌证，但已表明 IPF 会增加胸部放疗后发生严重和致命并发症的风险。质子束治疗在降低 IPF 患者胸部放疗相关危及生命并发症的发生率方面显示出良好的效果，但目前的证据还不足以推荐其常规使用。在发病机制和潜在机制方面，IPF 和 RILI 之间存在许多相似之处。更好地了解 IPF 和 RILI 的机制可能使临床医生能够为患有 IPF 的癌症患者提供更安全、更有效的胸部放疗治疗。在这篇综述中，我们总结了 IPF 的现有知识，阐述了 IPF 在放射肿瘤学实践中的重要性，并强调了 IPF 和 RILI 之间的相似性和关系。
