Liao Wan-Chuen, Shokr Hala, Faivre-Finn Corinne, Dempsey Clare, Williams Kaye Janine, Chen Li-Chia
Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PT, UK.
School of Dentistry, College of Medicine, National Taiwan University, Taipei 10048, Taiwan.
Pharmaceuticals (Basel). 2025 Jan 16;18(1):105. doi: 10.3390/ph18010105.
: ACEIs protect against radiation pneumonitis by reducing angiotensin II production, oxidative stress, and inflammation. This study highlights the significance of concurrent angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) use in radiotherapy by evaluating its impact on radiotherapy-related side effects and survival outcomes, addressing the gap in existing research and providing insights to guide clinical practice in oncology. : The literature was retrieved from the MEDLINE, EMBASE, Web of Science, and Scopus databases from January 2000 to October 2024. Studies on adults (≥18 years) with histologically confirmed cancer, receiving ACEIs or ARBs during radiotherapy, were included. Radiotherapy-related side effects and clinical outcomes were analysed using odds ratios (ORs) and 95% confidence intervals (95%CIs), comparing ACEI/ARB users to non-users. Differences in the median survival time, recurrence, and death rates were also calculated. : Sixteen studies (14 cohort studies and two randomised trials) were included. ACEI users exhibited a 50% reduction in the risk of ≥grade 2 radiation pneumonitis (OR: 0.50, 95%CI: 0.32-0.77) in lung cancer and significant reductions in the odds of proctitis (80%, OR: 0.20, 95%CI: 0.12-0.33), haematuria (75%, OR: 0.25, 95%CI: 0.16-0.41), and rectal bleeding (61%, OR: 0.39, 95%CI: 0.30-0.51) in prostate cancer. ACEI/ARB users showed reduced symptomatic radiation necrosis in brain metastases and better 6-month functional independence in supratentorial glioblastoma. Among six studies reporting survival, ACEI/ARB users had longer median survival in early-stage non-small-cell lung cancer and glioblastoma but shorter survival in small cell lung cancer and brain metastases. ARB users had inconsistent survival rates for lung cancer. The varying survival outcomes suggest that ACEIs/ARBs have different effects depending on the cancer type and stage, potentially influenced by cancer-specific factors, treatment protocols, or disease progression. : ACEI use is associated with a reduction in radiation pneumonitis, but evidence for other radiotherapy-related toxicity and survival outcomes remains inconsistent across cancer types and severities. Further research should carefully control for confounders.
血管紧张素转换酶抑制剂（ACEIs）通过减少血管紧张素II的产生、氧化应激和炎症反应来预防放射性肺炎。本研究通过评估血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）在放疗中的使用对放疗相关副作用和生存结局的影响，突出了其在放疗中联合使用的重要性，填补了现有研究的空白，并为肿瘤学临床实践提供了指导见解。
从2000年1月至2024年10月，检索MEDLINE、EMBASE、Web of Science和Scopus数据库中的文献。纳入了对组织学确诊癌症的成年人（≥18岁）在放疗期间使用ACEIs或ARBs的研究。使用优势比（ORs）和95%置信区间（95%CIs）分析放疗相关副作用和临床结局，将ACEI/ARB使用者与非使用者进行比较。还计算了中位生存时间、复发率和死亡率的差异。
纳入了16项研究（14项队列研究和2项随机试验）。ACEI使用者在肺癌中发生≥2级放射性肺炎的风险降低了50%（OR：0.50，95%CI：0.32 - 0.77），在前列腺癌中直肠炎（80%，OR：0.20，95%CI：0.12 - 0.33）、血尿（75%，OR：0.25，95%CI：0.16 - 0.41）和直肠出血（61%，OR：0.39，95%CI：0.30 - 0.51）的发生率显著降低。ACEI/ARB使用者在脑转移中症状性放射性坏死减少，在幕上胶质母细胞瘤中6个月功能独立性更好。在六项报告生存情况的研究中，ACEI/ARB使用者在早期非小细胞肺癌和胶质母细胞瘤中的中位生存时间更长，但在小细胞肺癌和脑转移中生存时间较短。ARB使用者在肺癌中的生存率不一致。生存结局的差异表明，ACEIs/ARBs的效果因癌症类型和分期而异，可能受癌症特异性因素、治疗方案或疾病进展的影响。
使用ACEI与放射性肺炎的减少相关，但关于其他放疗相关毒性和生存结局的证据在不同癌症类型和严重程度之间仍不一致。进一步的研究应仔细控制混杂因素。
