Wolf Colten, Wesolowski Michael, Stang Kyle, Alite Fiori, Harkenrider Matthew
Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA.
Biostatistics, Loyola University Chicago Stritch School of Medicine, Maywood, USA.
Cureus. 2022 Jun 16;14(6):e25994. doi: 10.7759/cureus.25994. eCollection 2022 Jun.
Radiation pneumonitis (RP) is a local inflammatory response, and we hypothesize that RP serves as an immune stimulator and is a protective factor against disease progression. Methods: We analyzed patients with early-stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT) at two institutions. Radiographic RP (RRP) was evaluated and maximal axial dimensions were measured at three-, six-, and twelve-month timepoints with surveillance CT. RRP was measured using radiographic markers such as ground-glass opacities and airspace consolidation. Disease recurrence was evaluated and categorized as local, regional, and distant. Results: Seventy-seven unique patient records were randomly selected from the database, 72 patients (93.5%) had RRP and five patients (6.5%) did not. The median follow-up was 24.3 months (IQR: 12.0 - 41.9). Disease failure occurred in 28.6% of patients with 6.5% local only, 2.6% regional only, 7.8% distant only, and 11.7% with multiple recurrences. Patients with RRP demonstrated a lower rate of disease failure with 25.0% of those with RRP experiencing disease failure and 80% of those without RRP experiencing disease failure (p=0.02). Patients with RRP had a 71% reduced risk of disease recurrence, compared to patients with no RRP, after adjusting for maximum tumor dimension (HR 0.29, p = 0.05). Among patients with RRP, there was no significant difference in recurrence based on extent of RRP (maximal area of RRP on CT). RRP did not correlate with overall survival. Discussion: Most patients who received SBRT had RRP, and this study suggests that it may be protective of cancer recurrence. These results are hypothesis-generating and will need to be validated in larger and independent datasets.
放射性肺炎（RP）是一种局部炎症反应，我们推测RP作为一种免疫刺激剂，是预防疾病进展的保护因素。方法：我们分析了在两家机构接受立体定向体部放射治疗（SBRT）的早期非小细胞肺癌（NSCLC）患者。通过监测CT在3个月、6个月和12个月时间点评估影像学RP（RRP）并测量最大轴向尺寸。使用磨玻璃影和实变等影像学标记测量RRP。评估疾病复发情况并分为局部、区域和远处复发。结果：从数据库中随机选择77份独特的患者记录，72例患者（93.5%）出现RRP，5例患者（6.5%）未出现。中位随访时间为24.3个月（四分位间距：12.0 - 41.9）。28.6%的患者出现疾病进展，其中仅局部进展6.5%，仅区域进展2.6%，仅远处进展7.8%，多发复发11.7%。出现RRP的患者疾病进展率较低，出现RRP的患者中有25.0%出现疾病进展，未出现RRP的患者中有80%出现疾病进展（p = 0.02）。在调整最大肿瘤尺寸后，与未出现RRP的患者相比，出现RRP的患者疾病复发风险降低71%（风险比0.29，p = 0.05）。在出现RRP的患者中，基于RRP范围（CT上RRP的最大面积）的复发无显著差异。RRP与总生存期无关。讨论：大多数接受SBRT的患者出现RRP，本研究表明其可能对癌症复发具有保护作用。这些结果只是初步的，需要在更大的独立数据集中进行验证。
