乳腺癌放疗后的肺炎和纤维化：发生和与治疗相关的预测因素。
Pneumonitis and fibrosis after breast cancer radiotherapy: occurrence and treatment-related predictors.
机构信息
Department of Oncology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
出版信息
Acta Oncol. 2021 Dec;60(12):1651-1658. doi: 10.1080/0284186X.2021.1976828. Epub 2021 Oct 7.
BACKGROUND
Radiation pneumonitis (RP) and radiation fibrosis (RF) are common side effects after breast cancer (BC) radiotherapy (RT). However, there is a great variation in the frequency of RP and RF. This study presents the occurrence of- and the treatment-related predictors for RP and RF. Further, physician- and patient-reported pulmonary symptoms during the first year after postoperative RT for BC are demonstrated.
MATERIALS AND METHODS
From 2007 to 2008, 250 BC patients referred for postoperative RT were included in a prospective cohort study and followed during the first year after RT. High-resolution computed tomography of the lungs and symptom registration were performed before RT and 3, 6, and 12 months after RT. Patient-reported symptoms were registered by standard quality of life questionnaires. Logistic regression analyses were applied to estimate treatment-related predictors for radiological RP (rRP), clinical RP (cRP), radiological RF (rRF), and clinical RF (cRF).
RESULTS
The occurrence of rRP and cRP at three months was 78% and 19%, while 12 months after RT rRF and cRF was 89% and 16%, respectively; all reported as grade 1. In multivariable analyses, mastectomy predicted cRP at three months (OR = 2.48, = .03) and cRF at six months, ipsilateral lung volume receiving 20 Gray or more (V20), V30, and mean lung dose (MLD) predicted rRP at six months (OR = 1.06, = .0003; OR = 1.10, = .001; and OR = 1.03, = .01, respectively). Endocrine treatment predicted cRF at 12 months (OR = 2.48, = .02). Physicians reported significant more dyspnea at 3 months ( = .003) and patients reported 'a little dyspnea' more at 3 and 12 months compared to baseline ( = .007).
CONCLUSION
RP and RF are prevalent in the first year after BC radiation. Mastectomy predicted cRP at three months. V20, V30, D25, and MLD predicted rRP at 6 months, and endocrine treatment predicted cRF at 12 months. Patients and physicians reported dyspnea differently.
背景
放射性肺炎（RP）和放射性肺纤维化（RF）是乳腺癌（BC）放射治疗（RT）后的常见副作用。然而，RP 和 RF 的频率差异很大。本研究介绍了 RP 和 RF 的发生情况以及与治疗相关的预测因素。此外，还展示了 BC 术后 RT 后第一年医生和患者报告的肺部症状。
材料和方法
2007 年至 2008 年，纳入了 250 例接受术后 RT 的 BC 患者进行前瞻性队列研究，并在 RT 后第一年进行随访。在 RT 前、RT 后 3、6 和 12 个月进行肺部高分辨率计算机断层扫描和症状登记。患者报告的症状通过标准生活质量问卷进行登记。应用逻辑回归分析来估计与放射学 RP（rRP）、临床 RP（cRP）、放射学 RF（rRF）和临床 RF（cRF）相关的治疗预测因素。
结果
在 3 个月时，rRP 和 cRP 的发生率分别为 78%和 19%，而在 RT 后 12 个月时，rRF 和 cRF 的发生率分别为 89%和 16%，均报告为 1 级。多变量分析显示，乳房切除术预测了 3 个月时的 cRP（OR=2.48， = .03）和 6 个月时的 cRF，同侧肺接受 20Gy 或以上（V20）、V30 和平均肺剂量（MLD）预测了 6 个月时的 rRP（OR=1.06， = .0003；OR=1.10， = .001；OR=1.03， = .01）。内分泌治疗预测了 12 个月时的 cRF（OR=2.48， = .02）。医生在 3 个月时报告了明显更多的呼吸困难（ = .003），而患者在 3 个月和 12 个月时报告了“有点呼吸困难”（ = .007）比基线时更多。
结论
RP 和 RF 在 BC 放射治疗后第一年很常见。乳房切除术预测了 3 个月时的 cRP。V20、V30、D25 和 MLD 预测了 6 个月时的 rRP，而内分泌治疗预测了 12 个月时的 cRF。患者和医生报告的呼吸困难情况不同。
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