Anscher M S, Murase T, Prescott D M, Marks L B, Reisenbichler H, Bentel G C, Spencer D, Sherouse G, Jirtle R L
Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710.
Int J Radiat Oncol Biol Phys. 1994 Oct 15;30(3):671-6. doi: 10.1016/0360-3016(92)90954-g.
To determine whether plasma transforming growth factor-beta (TGF-beta) levels measured before and during radical radiotherapy for lung cancer could be used to predict patients at risk for the development of radiation pneumonitis.
The first eight patients with lung cancer (nonsmall cell: seven, small cell: one) enrolled in a prospective study designed to evaluate physiological and molecular biologic correlates of radiation induced normal tissue injury are described. The study began in June 1991. All patients were treated with radiotherapy with curative intent. Plasma transforming growth factor-beta levels were obtained before, weekly during, and at each follow-up after treatment. Pretreatment pulmonary function tests and single photon emission computed tomography scans were obtained to assess baseline lung function and were repeated at follow-up visits. Dose-volume histogram analyses were performed to determine the volume of lung which received > or = 30 Gy. Patients were assessed at each follow-up visit for signs and symptoms of pneumonitis.
Five patients developed signs and/or symptoms of pulmonary injury consistent with pneumonitis and three patients did not. In all three patients not developing pneumonitis, plasma TGF-beta levels normalized by the end of radiotherapy. In contrast, four out of five patients who suffered pneumonitis had persistently elevated plasma TGF-beta levels by the end of therapy. This finding appeared to be independent of the volume of irradiated lung.
These results suggest that plasma TGF-beta levels during treatment may be useful to determine which patients are at high risk of developing symptomatic pneumonitis following thoracic radiotherapy. This finding may have implications when planning additional therapy (either chemotherapy or radiotherapy) which may have potentially adverse consequences on the lung.
确定在肺癌根治性放疗前及放疗期间所检测的血浆转化生长因子-β（TGF-β）水平是否可用于预测有发生放射性肺炎风险的患者。
描述了参与一项前瞻性研究的首批8例肺癌患者（非小细胞肺癌：7例，小细胞肺癌：1例），该研究旨在评估辐射诱导的正常组织损伤的生理和分子生物学相关性。研究于1991年6月开始。所有患者均接受根治性放疗。在治疗前、治疗期间每周以及治疗后的每次随访时获取血浆转化生长因子-β水平。进行治疗前肺功能测试和单光子发射计算机断层扫描以评估基线肺功能，并在随访时重复进行。进行剂量体积直方图分析以确定接受≥30 Gy照射的肺体积。在每次随访时评估患者是否有肺炎的体征和症状。
5例患者出现了与肺炎一致的肺损伤体征和/或症状，3例患者未出现。在所有3例未发生肺炎的患者中，放疗结束时血浆TGF-β水平恢复正常。相比之下，5例发生肺炎的患者中有4例在治疗结束时血浆TGF-β水平持续升高。这一发现似乎与受照射肺的体积无关。
这些结果表明，治疗期间的血浆TGF-β水平可能有助于确定哪些患者在胸部放疗后有发生症状性肺炎的高风险。这一发现可能对计划可能对肺有潜在不良后果的额外治疗（化疗或放疗）具有启示意义。
