Segawa Y, Takigawa N, Kataoka M, Takata I, Fujimoto N, Ueoka H
Department of Internal Medicine, National Shikoku Cancer Center Hospital, Matsuyama, Japan.
Int J Radiat Oncol Biol Phys. 1997 Aug 1;39(1):91-8. doi: 10.1016/s0360-3016(97)00297-6.
To determine the risk factors contributing to development of radiation pneumonitis (RP) in patients with lung cancer who undergo radiation therapy to the thorax.
Development and severity of RP were retrospectively analyzed for 89 patients with lung cancer who underwent radiation therapy with or without chemotherapy at the National Shikoku Cancer Center Hospital between 1991 and 1995. The severity of RP was determined using a modified grading scale based on that of the Radiation Therapy Oncology Group and the European Organization for the Research and Treatment of Cancer.
Fifty-two (58%) patients developed RP: 34 patients with Grade 1, 5 with Grade 2, 8 with Grade 3, and 5 with Grade 5 RP. Severe RP tended to develop earlier than less severe RP, but not to a significant extent (p = 0.151). On logistic regression analysis including both patient condition and treatment factors, development of Grade 1 or more severe RP was most frequently observed for Stage I-II disease (p = 0.011). The use of chemotherapy, large daily radiation dose, and once-daily fractionation (vs. twice-daily fractionation) were possibly related to the development of RP (p = 0.057, p = 0.069, and p = 0.092, respectively). For the group of 48 patients who underwent chemoradiation therapy, the use of large daily radiation dose was a significant risk factor for RP (p = 0.014). In addition, the use of once-daily fractionation was a marginally significant risk factor (p = 0.052). Among chemotherapy drugs administered, cisplatin was a favorable factor (p = 0.011), while adriamycin was a risk factor (p = 0.061).
In radiation therapy for lung cancer, administration of a large daily dose should be avoided in order to prevent RP, particularly when radiation therapy is combined with chemotherapy.
确定接受胸部放射治疗的肺癌患者发生放射性肺炎（RP）的危险因素。
回顾性分析了1991年至1995年期间在四国癌症中心医院接受放射治疗（无论是否联合化疗）的89例肺癌患者RP的发生情况和严重程度。RP的严重程度采用基于放射治疗肿瘤学组和欧洲癌症研究与治疗组织的改良分级量表进行判定。
52例（58%）患者发生了RP：34例为1级，5例为2级，8例为3级，5例为5级RP。重度RP往往比轻度RP更早发生，但差异无统计学意义（p = 0.151）。在纳入患者情况和治疗因素的逻辑回归分析中，I-II期疾病最常发生1级或更严重的RP（p = 0.011）。化疗的使用、每日大剂量放疗以及每日一次分割放疗（与每日两次分割放疗相比）可能与RP的发生有关（分别为p = 0.057、p = 0.069和p = 0.092）。对于48例接受放化疗的患者，每日大剂量放疗是RP的显著危险因素（p = 0.014）。此外，每日一次分割放疗是边缘性显著危险因素（p = 0.052）。在使用的化疗药物中，顺铂是有利因素（p = 0.011），而阿霉素是危险因素（p = 0.061）。
在肺癌放射治疗中，为预防RP应避免每日大剂量给药，尤其是在放射治疗联合化疗时。
