Pagel J, Mohorn M, Kloetzer K H, Fleck M, Wendt T G
Abteilung Strahlentherapie, Klinik und Poliklinik für Radiologie, Friedrich-Schiller-Universität Jena.
Strahlenther Onkol. 1998 Jan;174(1):25-9. doi: 10.1007/BF03038224.
Pneumonitis is a typical subacute reaction of healthy bronchial tissue to thoracic irradiation. The purpose of the present trial was to show whether prophylactic application of steroids in the course of and following radiotherapy would reduce the incidence of pneumonitis.
Fifty-seven patients receiving thoracic irradiation for bronchial carcinoma were assigned to 2 therapeutic groups; half of the patients were given 10 mg of oral prednisolone per day, while the other half received daily inhalative beclomethasone. All patients were evaluated for radiographic signs of pneumonitis. Thirty-two patients received additional investigations for pulmonary diffusion capacity of carbon monoxide.
The overall incidence of pneumonitis was 17.6% (10/57 patients). Neither total radiation dose nor mode of fractionation did significantly contribute to the incidence of pneumonitis. Those patients showing a pulmonary diffusion capacity for carbon monoxide of less than 60% prior to radiotherapy had a significantly higher risk of developing pneumonitis (4/7) than patients with a higher diffusion capacity (3/25, p = 0.026). In follow-up period we did not see significant changes in diffusion capacity neither with patients who developed pneumonitis nor with those patients showing no evidence of pulmonary injury. Comparing the chest X-ray there were less radiographic changes consistent with pneumonitis in the inhalative beclomethasone (2/28) than in the oral prednisolone group (8/29, p = 0.045).
In order to reduce the incidence of pneumonitis in patients receiving thoracic irradiation we support a continuous application of steroids in the course of and following radiotherapy. The inhalative use of beclomethasone has proved to be superior to oral prednisolone due to better local efficacy and decreased unwanted side effects.
肺炎是健康支气管组织对胸部放疗的典型亚急性反应。本试验的目的是表明在放疗期间及放疗后预防性应用类固醇是否会降低肺炎的发生率。
57例因支气管癌接受胸部放疗的患者被分为2个治疗组；一半患者每天口服10毫克泼尼松龙，另一半患者每天吸入倍氯米松。对所有患者进行肺炎影像学征象评估。32例患者接受了一氧化碳肺弥散功能的额外检查。
肺炎的总发生率为17.6%（10/57例患者）。总辐射剂量和分割方式均未对肺炎发生率产生显著影响。放疗前一氧化碳肺弥散功能低于60%的患者发生肺炎的风险（4/7）显著高于弥散功能较高的患者（3/25，p = 0.026）。在随访期间，发生肺炎的患者和未出现肺损伤证据的患者的弥散功能均未出现显著变化。比较胸部X线片，吸入倍氯米松组（2/28）与肺炎相符的影像学改变少于口服泼尼松龙组（8/29，p = 0.045）。
为降低接受胸部放疗患者的肺炎发生率，我们支持在放疗期间及放疗后持续应用类固醇。由于局部疗效更好且副作用减少，吸入倍氯米松已被证明优于口服泼尼松龙。
