Hennequin C, Tredaniel J, Chevret S, Durdux C, Dray M, Manoux D, Perret M, Bonnaud G, Homasson J P, Chotin G, Hirsch A, Maylin C
Service de Cancérologie-Radiothérapie, Höpital Saint-Louis, Paris, France.
Int J Radiat Oncol Biol Phys. 1998 Aug 1;42(1):21-7. doi: 10.1016/s0360-3016(98)00032-7.
To determine the predictive factors associated with hemoptysis and radiation bronchitis after endobronchial brachytherapy by univariate and multivariate analyses
One hundred forty-nine patients underwent endobronchial brachytherapy and were divided into three therapeutic groups: group 1: patients treated with palliative intent (n=47); group 2: patients treated with curative intent (small endobronchial tumors without mediastinal or general dissemination: n=73); group 3: patients also receiving external irradiation (n=29). One hundred twelve patients had previously received external irradiation. Brachytherapy was delivered with a dose per fraction ranging from 4 to 7 Gy and a prescription point between 0.5 and 1.5 cm, usually 1 cm from the source center. Two to six fractions were delivered according to the therapeutic group and clinical situation. The influence of the following variables on the incidence of hemoptysis or radiation bronchitis was studied: age, sex, Karnofsky score, therapeutic group, histologic type, endoscopic tumor length, dose per fraction, total brachytherapy dose, total external beam irradiation dose, total dose (brachytherapy dose plus external irradiation dose), volumes of the 100% and 200% isodoses, and volumes of the 7 and 14 Gy isodoses.
We observed 11 hemoptyses (7.4%), 10 were lethal. All but one occurred in patients with progressive disease. Two clinical factors were significantly associated with hemoptysis by univariate analysis: palliative group (p=0.009) and endobronchial tumor length (p=0.004). No technical factors seem to be implicated in the occurrence of hemoptysis. Only endobronchial tumor length remained in the multivariate model (p=0.02). Radiation bronchitis was observed in 13 cases (8.7%). By univariate analysis, a good Karnofsky score (p=0.02), curative treatment (p=0.02), and tumor location on trachea and main stem bronchus (p=0.002) were significantly associated with this complication. Two technical factors were also incriminated: the total dose (p=0.04) and the 100% isodose volume (p=0.02). By multivariate analysis, only the tumor location retained statistical significance (p=0.009).
Hemoptysis is most likely due to disease progression, with the bleeding being facilitated by brachytherapy. Some rare cases could be a direct complication of brachytherapy itself, particularly when tumors are located in the upper lobes. In contrast, radiation bronchitis occurred more frequently in patients with controlled disease, and was significantly influenced by tumor location and technical factors (dose and volumes treated). Technical improvements should increase the therapeutic ratio.
通过单因素和多因素分析确定与支气管内近距离放射治疗后咯血和放射性支气管炎相关的预测因素
149例患者接受了支气管内近距离放射治疗，并分为三个治疗组：第1组：姑息性治疗患者（n = 47）；第2组：根治性治疗患者（支气管内小肿瘤，无纵隔或全身播散：n = 73）；第3组：同时接受外照射的患者（n = 29）。112例患者先前接受过外照射。近距离放射治疗的分次剂量范围为4至7 Gy，处方点在0.5至1.5 cm之间，通常距源中心1 cm。根据治疗组和临床情况给予2至6次分次照射。研究了以下变量对咯血或放射性支气管炎发生率的影响：年龄、性别、卡诺夫斯基评分、治疗组、组织学类型、内镜下肿瘤长度、分次剂量、近距离放射治疗总剂量、外照射总剂量、总剂量（近距离放射治疗剂量加外照射剂量）、100%和200%等剂量线体积以及7和14 Gy等剂量线体积。
我们观察到11例咯血（7.4%），其中10例致命。除1例发生在病情进展的患者外，其余均如此。单因素分析显示，有两个临床因素与咯血显著相关：姑息治疗组（p = 0.009）和支气管内肿瘤长度（p = 0.004）。咯血的发生似乎与技术因素无关。多因素模型中仅保留了支气管内肿瘤长度（p = 0.02）。观察到13例放射性支气管炎（8.7%）。单因素分析显示，良好的卡诺夫斯基评分（p = 0.02）、根治性治疗（p = 0.02）以及肿瘤位于气管和主支气管（p = 0.002）与该并发症显著相关。两个技术因素也被认为有影响：总剂量（p = 0.04）和100%等剂量线体积（p = 0.02）。多因素分析显示，仅肿瘤位置具有统计学意义（p = 0.009）。
咯血很可能是由于疾病进展，近距离放射治疗促进了出血。一些罕见病例可能是近距离放射治疗本身的直接并发症，尤其是当肿瘤位于上叶时。相比之下，放射性支气管炎在病情得到控制的患者中更常见，并且受肿瘤位置和技术因素（剂量和治疗体积）的显著影响。技术改进应提高治疗比率。
