Hardman P D, Tweeddale P M, Kerr G R, Anderson E D, Rodger A
Department of Clinical Oncology, Western General Hospital, Edinburgh, UK.
Radiother Oncol. 1994 Jan;30(1):33-42. doi: 10.1016/0167-8140(94)90007-8.
Eighty-five patients treated with loco-regional radiotherapy to the breast/chest wall and cervico-axillary nodes, and 16 patients treated with local radiotherapy to the breast/chest wall alone for breast cancer were enrolled in a prospective study to measure the effects of treatment on pulmonary function during the acute phase (10 weeks after completing irradiation) and during the late phase (12 months after completing irradiation). Baseline pulmonary function values were obtained from all patients immediately prior to commencing radiotherapy. Twenty-two patients (25.8%) treated with loco-regional radiotherapy developed transient chest symptoms compared with two patients (12.5%) treated with local radiotherapy (P = 0.11). Patients undergoing loco-regional radiotherapy showed a reduction of mean vital capacity of 0.13 litres (4.2%) (P < 0.0001) during the acute phase and at 1 year a further decrease occurred (P = 0.02) so that mean vital capacity was reduced by 0.18 litres (5.8%) (P < 0.0001) compared to pretreatment values. Mean transfer factor for carbon monoxide (TLCO) was reduced by 0.85 mmol.kPa-1.min-1 [11.9%] (P < 0.0001) during the acute phase and remained unchanged at 1 year. Patients undergoing local radiotherapy to the breast/chest wall alone did not show any significant loss of vital capacity but mean TLCO was reduced during the acute phase by 0.65 mmol.kPa-1.min-1 (8.3%) (P < 0.002) which remained unchanged at 1 year. No significant association was found between impairment of ventilation or gas transfer and respiratory history, smoking history, concurrent respiratory symptoms, age, side treated or physiological pulmonary function in either the acute or late phase. This study has quantified some of the physiological sequelae following local and loco-regional radiotherapy for breast cancer. There is no evidence to suggest that any of the above factors are relevant to deciding which patients should, or should not, be offered local or loco-regional radiotherapy for breast cancer.
85例接受乳房/胸壁及颈腋淋巴结局部区域放疗的乳腺癌患者，以及16例仅接受乳房/胸壁局部放疗的乳腺癌患者被纳入一项前瞻性研究，以测量治疗在急性期（完成放疗后10周）和后期（完成放疗后12个月）对肺功能的影响。所有患者在开始放疗前即刻获取基线肺功能值。接受局部区域放疗的22例患者（25.8%）出现短暂胸部症状，而接受局部放疗的2例患者（12.5%）出现此类症状（P = 0.11）。接受局部区域放疗的患者在急性期平均肺活量降低0.13升（4.2%）（P < 0.0001），1年后进一步下降（P = 0.02），与治疗前值相比，平均肺活量降低0.18升（5.8%）（P < 0.0001）。急性期一氧化碳平均转移因子（TLCO）降低0.85 mmol·kPa⁻¹·min⁻¹ [11.9%]（P < 0.0001），1年时保持不变。仅接受乳房/胸壁局部放疗的患者肺活量无显著损失，但急性期平均TLCO降低0.65 mmol·kPa⁻¹·min⁻¹（8.3%）（P < 0.002），1年时保持不变。在急性期或后期，通气或气体交换受损与呼吸病史、吸烟史、并发呼吸道症状、年龄、治疗侧别或生理肺功能之间均未发现显著关联。本研究对乳腺癌局部及局部区域放疗后的一些生理后遗症进行了量化。没有证据表明上述任何因素与决定哪些患者应或不应接受乳腺癌局部或局部区域放疗相关。
