Speiser B L, Spratling L
Department of Radiation Oncology, St. Joseph's Hospital, Phoenix, AZ 85013.
Int J Radiat Oncol Biol Phys. 1993 Mar 15;25(4):589-97. doi: 10.1016/0360-3016(93)90003-e.
To describe a new clinical entity observed in follow-up bronchoscopies in patients who were treated with high dose rate and medium dose rate remote afterloading brachytherapy of the tracheobronchial tree.
Patients treated by protocol with medium dose rate, 47 patients receiving 1000 cGy at a 5 mm depth times three fractions, high dose rate 144 patients receiving 1000 cGy at a 10 mm depth for three fractions and high dose rate 151 patients receiving 750 cGy at a 10 mm depth for three fractions followed by bronchoscopy.
Incidence of this entity was 9% for the first group, 12% for the second, and 13% for the third group. Reactions were grade 1 consisting of mild mucosal inflammatory response with a partial whitish circumferential membrane in an asymptomatic patient; grade 2, thicker complete white circumferential membrane with cough and/or obstructive problems requiring intervention; grade 3, severe inflammatory response with marked membranous exudate and mild fibrotic reaction; and grade 4 a predominant fibrotic reaction with progressive stenosis. Variables associated with a slightly increased incidence of radiation bronchitis and stenosis included: large cell carcinoma histology, curative intent, prior laser photoresection, and/or concurrent external radiation. Survival was the strongest predictor of the reaction.
Radiation bronchitis and stenosis is a new clinical entity that must be identified in the bronchial brachytherapy patients and treated appropriately.
描述在接受气管支气管树高剂量率和中剂量率远程后装近距离放射治疗的患者随访支气管镜检查中观察到的一种新的临床实体。
按照方案接受中剂量率治疗的患者，47例在5毫米深度接受1000厘戈瑞分三次照射；高剂量率治疗的患者中，144例在10毫米深度接受1000厘戈瑞分三次照射，151例在10毫米深度接受750厘戈瑞分三次照射，之后进行支气管镜检查。
该实体的发生率在第一组为9%，第二组为12%，第三组为13%。反应分为1级，表现为无症状患者出现轻度黏膜炎症反应，伴有部分白色环形膜；2级，较厚的完整白色环形膜，伴有咳嗽和/或阻塞性问题，需要干预；3级，严重炎症反应，伴有明显的膜性渗出物和轻度纤维化反应；4级，以纤维化反应为主，伴有进行性狭窄。与放射性支气管炎和狭窄发生率略有增加相关的变量包括：大细胞癌组织学类型、治愈意图、既往激光光切除术和/或同期外照射。生存是反应的最强预测因素。
放射性支气管炎和狭窄是一种新的临床实体，必须在支气管近距离放射治疗患者中识别并进行适当治疗。
