Zanini Umberto, Faverio Paola, Bonfanti Valentina, Falzone Maria, Cortinovis Diego, Arcangeli Stefano, Petrella Francesco, Ferrara Giovanni, Mura Marco, Luppi Fabrizio
Department of Medicine and Surgery, University of Milano-Bicocca, SC Pneumologia, Fondazione IRCCS "San Gerardo dei Tintori", 20900 Monza, Italy.
Department of Medicine and Surgery, University of Milano-Bicocca, SC Oncologia, Fondazione IRCCS "San Gerardo dei Tintori", 20900 Monza, Italy.
J Clin Med. 2024 Nov 23;13(23):7085. doi: 10.3390/jcm13237085.
Patients with interstitial lung disease (ILD) are about five times more likely to develop lung cancer than those without ILD. The presence of ILD in lung cancer patients complicates diagnosis and management, resulting in lower survival rates. Diagnostic and treatment procedures needed for cancer can increase the risk of acute exacerbation (AE), one of the most severe complications for these patients. Bronchoscopic techniques are generally considered safe, but they can trigger AE-ILD, particularly after cryoprobe biopsies. Surgical procedures for lung cancer, including lung biopsies and resections, carry an elevated risk of AE-ILD. Postoperative complications and mortality rates highlight the importance of meticulous surgical planning and postoperative care. Furthermore, cancer treatments, such as chemotherapy, are all burdened by a risk of AE-ILD occurrence. Radiotherapy is important for managing both early-stage and advanced lung cancer, but it also poses risks. Stereotactic body radiation and particle beam therapies have varying degrees of safety, with the latter potentially offering a lower risk of AE. Percutaneous ablation techniques can help patients who are not eligible for surgery. However, these procedures may complicate ILD, and their associated risks still need to be fully understood, necessitating further research for improved safety. Overall, while advancements in lung cancer treatment have improved outcomes for many patients, the complexity of managing patients with concomitant ILD needs careful consideration and multidisciplinary assessment. This review provides a detailed evaluation of these risks, emphasizing the need for personalized treatment approaches and monitoring to improve patient outcomes in this challenging population.
间质性肺疾病(ILD)患者患肺癌的可能性是无ILD患者的五倍左右。肺癌患者中ILD的存在使诊断和管理变得复杂,导致生存率降低。癌症所需的诊断和治疗程序会增加急性加重(AE)的风险,AE是这些患者最严重的并发症之一。支气管镜技术通常被认为是安全的,但它们可能引发AE-ILD,尤其是在冷冻探头活检后。肺癌的外科手术,包括肺活检和切除术,会增加AE-ILD的风险。术后并发症和死亡率凸显了精心的手术规划和术后护理的重要性。此外,癌症治疗,如化疗,都存在发生AE-ILD的风险。放射治疗对早期和晚期肺癌的治疗都很重要,但也有风险。立体定向体部放疗和粒子束疗法的安全性各不相同,后者发生AE的风险可能较低。经皮消融技术可以帮助那些不适合手术的患者。然而,这些操作可能会使ILD复杂化,其相关风险仍需充分了解,需要进一步研究以提高安全性。总体而言,虽然肺癌治疗的进展改善了许多患者的治疗效果,但管理合并ILD患者的复杂性需要仔细考虑和多学科评估。本综述对这些风险进行了详细评估,强调需要个性化的治疗方法和监测,以改善这一具有挑战性的人群的患者治疗效果。