Gollins S W, Ryder W D, Burt P A, Barber P V, Stout R
Department of Radiotherapy, Christie Hospital, Withington, Manchester, UK.
Radiother Oncol. 1996 May;39(2):105-16. doi: 10.1016/0167-8140(96)01731-8.
Four hundred and six patients with primary non-small cell carcinoma of the bronchus causing symptoms due to endobronchial disease, were treated with intraluminal radiotherapy (ILT) using the microSelectron-HDR machine at the Christie Hospital, Manchester, between April 1988 and the end of 1992. An assessment of morbidity for this treatment is presented, particularly with regard to the risk factors and causes of massive haemoptysis death. The most common early side-effect was a mild transient exacerbation of cough which usually resolved within 2-3 weeks. At various times following ILT treatment 83 bronchoscopies were carried out randomly in 55 patients. In bronchoscopies carried out within the first 3 months following ILT, no tumour was visible in 80% of cases. A mucosal radiation reaction score (RRS) was used to grade bronchoscopic appearance after ILT treatment. Overall, 55% of bronchoscopic examinations showed some degree of mucosal radiation reaction. The majority of radiation reactions from 6 months onwards after ILT demonstrated a degree of fibrosis. A radiation reaction was seen more frequently after treatment with 2000 cGy as opposed to 1500 cGy at 1 cm from the central axis of the radiation source. Thirty-two patients were identified who had died from massive haemoptysis (MH) as a terminal event. A Cox multivariate regression analysis showed that the treatment-related factors of increased dose at first ILT (P = 0.004), prior laser treatment at the site of ILT (P = 0.020) and second ILT treatment in the same location as the first ILT treatment (P = 0.047), all significantly increased the relative risk of MH death compared with their effect on the relative risk of death from other causes (OC). (In addition a fourth treatment-related factor, namely the concurrent use of ILT and external beam radiotherapy (EB) had a P value of 0.08). Twenty out of 25 assessable MH-death patients (80%) had evidence of recurrent or residual tumour before death but 5 patients (20%) did not. For surviving patients the instantancious risk of death at any one time (the cause-specific death rate expressed as deaths per 100 cases per month), showed a sharp peak for MH deaths between 9 and 12 months post ILT in contradistinction to OC death where the peak was between 3 and 6 months post ILT. These findings may imply a role for late radiation reaction in the treatment-related risk factors identified as increasing the relative risk of MH death and possible mechanisms are discussed. The results have implications for treatment regimes that use a dose of 2000 cGy at 1 cm in a single fraction technique, that have a high frequency of previous laser treatment, that use multiple, repeated ILT treatments in the same location and that use ILT concurrently with EB.
1988年4月至1992年底期间，在曼彻斯特克里斯蒂医院，使用微型Selectron-HDR机器对406例因支气管内疾病出现症状的原发性支气管非小细胞癌患者进行了腔内放射治疗（ILT）。本文对该治疗的发病率进行了评估，尤其关注大出血死亡的危险因素和原因。最常见的早期副作用是咳嗽轻度短暂加重，通常在2 - 3周内缓解。在ILT治疗后的不同时间，对55例患者随机进行了83次支气管镜检查。在ILT后前3个月内进行的支气管镜检查中，80%的病例未见肿瘤。使用黏膜放射反应评分（RRS）对ILT治疗后的支气管镜表现进行分级。总体而言，55%的支气管镜检查显示有一定程度的黏膜放射反应。ILT后6个月起的大多数放射反应表现出一定程度的纤维化。在距放射源中心轴1 cm处，给予2000 cGy治疗后比给予1500 cGy治疗后更频繁出现放射反应。确定有32例患者因大出血（MH）作为终末事件死亡。Cox多因素回归分析显示，首次ILT时剂量增加（P = 0.004）、ILT部位先前接受激光治疗（P = 0.020）以及在与首次ILT相同部位进行第二次ILT治疗（P = 0.047），与这些因素对其他原因（OC）死亡相对风险的影响相比，均显著增加了MH死亡的相对风险。（此外，第四个与治疗相关的因素，即同时使用ILT和外照射放疗（EB），P值为0.08）。在25例可评估的MH死亡患者中，20例（80%）在死亡前有复发或残留肿瘤的证据，但5例（20%）没有。对于存活患者，任何时刻的即时死亡风险（以每100例每月死亡数表示的特定原因死亡率），MH死亡在ILT后9至12个月出现急剧峰值，这与OC死亡在ILT后3至6个月出现峰值形成对比。这些发现可能意味着晚期放射反应在被确定为增加MH死亡相对风险的治疗相关危险因素中起作用，并讨论了可能的机制。这些结果对采用单次分割技术在1 cm处给予2000 cGy剂量、先前激光治疗频率高、在同一部位多次重复进行ILT治疗以及同时使用ILT和EB的治疗方案具有启示意义。
