16例放射性肺损伤的X线观察

通过对16例放射性肺损伤资料的总结，讨论了照射剂量、照射野面积等因素与肺放射性损伤的发生及时间的关系，分析了肺损伤X线改变的动态表现，认为：（1）放射性肺损伤与放疗剂量及照射野面积关系密切，照射野面积大，能产生肺损伤的剂量相对就小，（2）急性放射性肺损伤多在放疗后1个月内出现；慢性肺纤维化平均在放疗后4.23个月出现，半年内纤维化发生率约为85.7%。（3）肺损伤的临床表现与X线征象不平行，临床表现程度一般较X线征象轻，此外，依据放射性肺损伤的X线表现及动态发生，还对肺损伤与肿瘤的间质性肺转移、普通肺炎及肿瘤放疗后复发的鉴别诊断进行了分析。     

乳腺癌胸壁照射加组织等效膜预防放射性肺炎的临床研究

放射性肺炎是乳腺癌胸壁放疗后常见的并发症，临床放射性肺炎的发生率为1％～34％，尤其在化疗2周期后更易诱发放射性肺炎。笔者观察乳腺癌根治术后，胸壁加和不加组织等效膜对肺放射性肺炎、肺损伤的影响。报告如下。     

血清CD4+/CD8+、PCT及KL-6水平与局部晚期NSCLC放疗后放射性肺炎严重程度的相关性研究

目的 研究血清分化决定族抗原4+/分化决定族抗原8+（CD4+/CD8+）、降钙素原（PCT）及涎液化糖链抗原（KL-6）水平与局部晚期非小细胞肺癌（NSCLC）放疗后重症放射性肺炎相关性。方法 选取2019年5月至2021年3月海安市人民医院收治的103例局部晚期NSCLC患者,根据放疗后放射性肺炎评估结果分组：未发生放射性肺炎作为对照组,共54例;发生放射性肺炎且分级在1~2级作为轻症组,共31例;分级≥3级患者作为重症组,共18例。分别于放疗前后检测3组血清CD4+/CD8+、PCT及KL-6水平,采用Logistic回归模型分析重症放射性肺炎影响因素。结果 单因素分析发现,三组放疗前KPS评分、FEV1/FVC、照射剂量＜60Gy比例、放疗后CD4+/CD8+、放疗后PCT、放疗后KL-6比较,差异具有统计学意义（P＜0.05）。其中重症组放疗前KPS评分、FEV1/FVC、照射剂量＜60Gy比例及放疗后CD4+/CD8+低于对照组与轻症组,且轻症组放疗前KPS评分、FEV1/FVC、照射剂量＜60Gy比例及放疗后CD4+/CD8+低于对照组。而重症组放疗后PCT、放疗后KL-6高于对照组与轻症组,且轻症组放疗后PCT,放疗后KL-6高于对照组（P＜0.05）。Logistic回归分析显示,放疗后血清CD4+/CD8+下降、PCT、KL-6水平升高、照射剂量≥60Gy为重症放射性肺炎的独立危险因素（P＜0.05）。结论 放疗结束后局部晚期NSCLC患者血清CD4+/CD8+下降,PCT、KL-6水平上升,照射剂量≥60Gy对预测重症放射性肺炎发生具有重要价值。     

放射性肺炎激素治疗临床分析

放射性肺炎又称作“症状性放射性肺损伤”，胸部X光片或胸部CT扫描可发现与照射区肺野形状、部位相关的渗出性实变影和(或)纤维化索条影。它是肺癌、食管癌、乳腺癌、恶性胸膜间皮瘤等患者接受胸部放疗时一种最常见的剂量限制性毒性反应，目前仍采用激素为主的综合治疗。关于激素应用的时机、剂量与疗程一直是临床医师关注的焦点，笔者通过回顾性分析33例放射性肺炎患者激素治疗的临床效果，探讨高效、合理的激素用药方案。     

上颈部纤维化对鼻咽癌患者放射性后组颅神经损伤的影响

目的探讨鼻咽癌患者中放射性后组颅神经（第Ⅸ-Ⅻ颅神经）损伤的影响因素,重点探讨其与上颈部纤维化的关系。方法分析317例生存5年以上的鼻咽癌患者。入组患者均为单程放疗,以^60Co或6MVX线照射,分别采用面颈联合野（62例）和耳前野放疗（255例）。鼻咽原发灶照射的中位剂量为71Gy（55-86Gy）,上颈部照射的中位剂量为61Gy（34-72Gy）。24例加用192Ir鼻咽腔内近距离放疗联合化疗45例。结果中位随访时间为11.4年（5.1-38.0年）。81例（25.5%）患者发生放射性后组颅神经损伤,年平均发病率为1.8%,5、10和20年的累积发病率分别为5.7%、17.4%和37.3%。根据SOMA标准,54例（17%）患者上颈部发生严重（3-4级）放射性纤维化。在上颈部出现严重放射性纤维化的患者中,放射性后组颅神经损伤的5年和10年累积发生率分别为22.2%和42.0%,而在无或轻度放射性纤维化患者中的发生率则分别为4.6%和12.1%,经Log-rank检验,两组病例之间差异有统计学意义（P〈0.001）。单因素分析结果还显示,鼻咽部总剂量大于70Gy（与≤70Gy相比）和采用耳前野放疗（与面颈联合野相比）的放射性后组颅神经损伤的发生率增加（P〈0.05）。在多因素分析中,上述3个影响因素差异仍具有统计学意义。结论放射性后组颅神经损伤除了与鼻咽部的放疗总剂量和放射野有关外,上颈部纤维化亦是重要的独立的影响因素,颅神经周围的纤维化可能是放射性颅神经损伤的发生机制之一。     

呼吸门控放疗非小细胞肺癌

目的 观察非小细胞肺癌呼吸门控放疗的近期疗效以及急性放射性肺炎发生率.方法 16例病理明确的非小细胞肺癌患者采用呼吸门控放射治疗,总剂量60 Gy,分30次照射,观察放疗后肿瘤退缩情况及放射性肺损伤.结果 近期总有效率为68.75％,5例患者发生Ⅱ级放射性肺炎,其他患者均为0～1级放射性肺炎.结论呼吸门控放疗有较好的近...     

放射性肺炎27例临床诊断分析

放射性肺炎多发生在肺癌、乳腺癌等胸部肿瘤放疗后，是较常见的并发症，我科从１９９５年８月至１９９７年６月，共收治肺癌和乳腺癌病人１１２例，放疗结束后３个月内有２７人发生放射性肺炎，发生率为２４．１％，现报告如下。材料与方法：本组病人男５７例，女５５例，...     

放射性肺损伤X线表现(附40例分析)

近年来，随着放射治疗学的普遍开展，对肺癌、食道癌、乳癌及纵隔肿瘤照射后造成的放射性肺损伤病例逐年增多。现将我院1990－1994年收治的40例放射性肺损伤的患者X线表现总结如下：材料与方法男性28例，女性12例，年龄42岁一65岁。本组病例原发病为①肺癌②食道癌③乳腺癌④纵隔肿瘤。机器类型：国产”C。放疗机。放疗方法：肺癌原发区及肺门区，纵隔区均采用‘’动常规分割照射，总剂量6o－75GY（5－7周）。乳腺癌术后内乳区及腋下区采用”CO常规分照射，剂量为50—65GY（5－7周）。照射面积为100cm’－200cm’。放疗前、后均有胸部X…     

剂量体积直方图评价肺癌的放射性肺损伤

放射治疗是肺癌的主要治疗手段之一，但局部控制率和生存率低，提高剂量可望提高局部控制率和生存率，三维适形放疗可适当提高靶区剂量，降低靶区周围正常组织的受照射剂量，从而降低并发症的发生率。剂量体积直方图（DVH）对正常组织的受照射剂量提供一个量化的体积一剂量分布图，根据它能够判断某一治疗计划产生正常组织并发症的可能性（NTCP），即肺放射损伤即急性放射性肺炎和放射性肺纤维化。笔者针对48例非小细胞肺癌患者进行根治性放疗，对其临床观察，同时借助于相关的NTCP模型分析放射性肺损伤情况。     

放射性肺炎对^18FDG PET在肿瘤放射治疗中作用影响的研究

目的研究放射性肺炎发生的时间规律、^18F-脱氧葡萄糖（FDG）PET图像的特点及对FDG EPT诊断的影响。方法选择胸部肿瘤施行放疗的患者共15例，放疗前后进行系列FDGPET全身检查。图像判断进行视觉分析和半定量分析。结果本组中有5例出现放射性肺炎，其图像特点为：病变为片状比较均匀的摄取增高影，边界与放疗照射野一致，且都在肺内靠后近胸膜处。截至随访结束时，例2及例4完全消失，而例1、例3仍有轻度摄取，例5则至放疗后13个月一直变化不大。放射性肺炎病变部位SLN随时间而减低，一般SUW在放疗后6个月内下降明显，其后变化较小。结论在放射治疗的各个阶段如果需要了解患者情况，FDG PET结果的判读应结合放疗病史及放射性肺炎不同时期的特点加以分析。     

Computed tomography to assess pulmonary injury associated with concurrent chemo-radiotherapy for inoperable non-small cell lung cancer.

OBJECTIVE: To characterize serial computed tomography (CT) findings of pulmonary injury after a uniform regimen of concurrent chemo-radiotherapy in inoperable non-small cell lung cancer, and to compare the radiation-induced lung toxicity with other concurrent chemo-radiation regimens. METHODS: Twenty-four patients with advanced non-small cell lung cancer received 2 induction cycles of cisplatin and vinblastine, followed by 2 further cycles of cisplatin and vinblastine, concurrent with 60 Gy radiation at 2 Gy per fraction. Radiation-induced lung injury in the acute and chronic phases was assessed by serial CT scans and compared with preradiation baseline scans. Acute radiation pneumonitis was evaluated using the Common Toxicity Criteria, and chronic radiation fibrosis was graded according to the European Organisation for Research and Treatment of Cancer--Radiation Therapy Oncology Group Scale. RESULTS: Seventeen (81%) patients had characteristic CT findings of radiation-induced pulmonary damage, which were confined to the radiation ports. Although patchy nonhomogeneous and air-space opacities characterized acute radiation pneumonitis, and homogeneous opacities with loss of volume were typical for chronic fibrosis, ground-glass opacities were found frequently in both phases. Acute radiation pneumonitis grade 1 was seen in 29% and grade 2 in 9.5%. Chronic radiation fibrosis grades 1, 2 and 3 were found in 14%, 33% and 19% of the patients respectively. Median survival time was 13 months. CONCLUSION: CT enables detailed evaluation of radiation-induced pulmonary injury after concurrent chemo-radiation for inoperable non-small cell lung cancer. Although survival time with the present regimen is comparable to other concurrent chemo-radiation regimens, a high incidence of radiation injury was found, though the severity was not life threatening.     

Radiation-induced lung disease and the impact of radiation methods on imaging features.

Although radiologic findings in radiation-induced lung disease are well described in the literature, the influence exerted on these findings by different radiation methods is not well understood. Radiation treatment of non-small cell lung cancer varies depending on the location and extent of disease. Irradiation with oblique beam angles results in unusual distribution of radiation-induced lung disease. Small cell lung cancer is treated with irradiation concurrent with or following chemotherapy, and portal arrangements are controversial. In breast cancer, use of tangential beam portals may induce radiation pneumonitis or fibrosis at the peripheral lung anterolaterally. Use of supraclavicular portals may produce lesions in the lung apex that appear similar to pulmonary tuberculosis. In esophageal cancer, radiation portals with a 5-6-cm margin above and below the tumor are generally recommended, and computed tomography (CT) frequently demonstrates radiation-related lung damage adjacent to the mediastinum. In mediastinal tumors, the mantle field includes all the major lymph node regions above the diaphragm. Radiation pneumonitis varies from minimal to extremely marked change in the paramediastinal areas and in both apices. CT is more sensitive to radiation-induced lung disease than chest radiography and demonstrates related changes earlier. Furthermore, it more clearly depicts the precise distribution and pattern of disease. Familiarity with the imaging findings in radiation-induced lung disease produced by different radiation methods will help radiologists interpret abnormalities seen at chest radiography and CT in affected patients.     

Correlation between lung fibrosis and radiation therapy dose after concurrent radiation therapy and chemotherapy for limited small cell lung cancer.

PURPOSE: To evaluate the relationship between physician-identified radiographic fibrosis, lung tissue physical density change, and radiation dose after concurrent radiation therapy and chemotherapy for limited small cell lung cancer. MATERIALS AND METHODS: Fibrosis volumes of different severity levels were delineated on computed tomography (CT) images obtained at 1-year follow-up of 21 patients with complete response to concurrent radiation therapy and chemotherapy for limited small cell lung carcinoma. Delivered treatments were reconstructed with a three-dimensional treatment planning system and geometrically registered to the follow-up CT images. Tissue physical density change and radiation dose were computed for each voxel within each fibrosis volume and within normal lung. Patient responses were grouped per radiation and chemotherapy protocol. RESULTS: A significant correlation was noted between fibrosis grade and tissue physical density change and fibrosis grade. For doses less than 30 Gy, the probability of observing fibrosis was less than 2% with conventional fractionation and less than 4% with accelerated fractionation. Physical lung density change also showed a threshold of 30-35 Gy. For doses of 30-55 Gy and cisplatin and etoposide (PE) chemotherapy, fibrosis probability was 2.0 times greater for accelerated fractionation compared with conventional fractionation (P < .005) and was correlated to increasing dose for both fractionation schedules. CONCLUSION: Lung tissue physical density changes correlated well with fibrosis incidence, and both increased with increasing dose greater than a threshold of 30-35 Gy. With concurrent PE chemotherapy, fibrosis probability was twice as great with accelerated fractionation as with once-daily fractionation.     

Dose-volumetric parameters for predicting severe radiation pneumonitis after three-dimensional conformal radiation therapy for lung cancer

PURPOSE: To retrospectively evaluate dose-volumetric parameters for association with risk of severe (grade >/=3) radiation pneumonitis (RP) in patients after three-dimensional (3D) conformal radiation therapy for lung cancer. MATERIALS AND METHODS: The study was approved by the institutional review board, which did not require informed consent. Data from 76 patients (66 men, 10 women; median age, 60 years; range, 35-79 years) with histologically proved lung cancer treated curatively with 3D conformal radiation therapy between August 2001 and October 2002 were retrospectively analyzed. Twenty patients underwent surgery before radiation therapy; 57 patients received chemotherapy. Median total radiation dose of 60 Gy (range, 54-66 Gy) was delivered in 30 (range, 27-33) fractions over 6 weeks. RP was scored by using Radiation Therapy Oncology Group criteria. Clinical parameters were analyzed. Dose-volumetric parameters analyzed were percentage of lung volume that received a dose of 20 Gy or more (V20), 30 Gy or more (V30), 40 Gy or more (V40), or 50 Gy or more (V50); mean lung dose (MLD); normal tissue complication probability (NTCP); and total dose. Fisher exact test was performed to compare clinical parameters between patients who developed severe RP and those who did not. Univariate and multivariate logistic regression analyses were performed to evaluate data for association between dose-volumetric parameters and severe RP. Pearson chi(2) test was used to assess data for correlations among dose-volumetric parameters. P < or = .05 was considered to indicate statistically significant difference. RESULTS: Of 76 patients, 30 (39%) did not develop RP; 23 (30%) developed RP of grade 1; 11 (14%), grade 2; 11 (14%), grade 3; and 1 (1%), grade 4. None had grade 5 RP. Age (< 60 vs > or =60), sex, Karnofsky performance status (< 70 vs > or =70), forced expiratory volume in 1 second, presence of weight loss, preexisting lung disease, history of thoracic surgery, and history of chemotherapy did not significantly differ between patients who developed severe RP and those who did not. In univariate analyses, MLD, V20, V30, V40, V50, and NTCP were associated with severe RP (P < .05). In multivariate analysis, MLD was the only variable associated with severe RP. CONCLUSION: MLD is a useful indicator of risk for development of severe RP after 3D conformal radiation therapy in patients with lung cancer.     

A case with delayed-onset radiation pneumonitis suspected to be induced by oral etoposide]

Radiation pneumonitis usually occurs within 1-3 months after the completion of radiation therapy. A 63-year-old male with primary lung cancer treated by radiation therapy developed radiation pneumonitis 5 months after the completion of radiation therapy. He received 60 Gy to the lung tumor in a conventional fractionation schedule, and then two courses of intravenous chemotherapy using cis-diamine-dichloroplatinum (II) (110-140 mg) and etoposide (140-175 mg). Oral etoposide was initiated for bone metastases on the 104th day after the completion of radiation therapy at a daily dose of 20 mg, to a total dose of 1075 mg. He complained of fever and exertional dyspnea 5 months after the completion of radiation therapy. Chest radiography showed homogeneous infiltrates in the irradiated lung. These clinical signs and symptoms were refractory to antibiotic therapy, but steroid therapy resulted in marked improvement. The development of radiation pneumonitis was suspected to be induced by oral etoposide, which was given before the onset of radiation pneumonitis. These data suggest that etoposide induces a recall phenomenon, as has been demonstrated with such drugs as adriamycin and actinomycin-D.     

Concurrent end-phase boost high-dose radiation therapy for non-small-cell lung cancer with or without cisplatin chemotherapy

The aim of this study was to audit the results of a high-dose, combined-modality prospective protocol for non-small-cell lung cancer in terms of survival, disease-specific survival and toxicity. One hundred and twenty-one patients with non-small-cell lung cancer were treated with a concurrent, end-phase, boost, high-dose radiotherapy protocol with 65 Gy in 35 fractions for more than 5 weeks. Sixty-six patients received radiotherapy alone (group 1), 29 received concurrent chemoradiation (group 2) and 26 received neoadjuvant and concurrent chemotherapy (group 3). Thirty-four patients had stage I disease, six had stage II and 81 had stage III. Overall median survival was 23 months: 75% at 1 year and 23% at 5 years. Median survivals for patients with stage I and stages II and III disease were 43 and 19 months, respectively. For stages II and III patients by groups 1-3, median survivals were 18, 25 and 18 months, respectively, and 2-year survivals were 36, 52 and 38%, respectively. Toxicity was acceptable. Overall, 9% had symptomatic pneumonitis and 7% had grades 3 and 4 oesophagitis. For those who had the mediastinum included in the volume, grade > or = 3 oesophagitis occurred in 0, 11 and 22% (n = 110, P = 0.001), respectively, for treatment groups 1-3. Overall treatment-related mortality was 3%, consisting of two septic deaths, one pneumonitis and possibly one late cardiac event, all occurring in patients who had chemotherapy (7% of 55 patients). Treatment-related mortality declined over the study period. Accelerated radiotherapy was well tolerated, with only moderate increased acute toxicity when combined with concurrent platinum chemotherapy. Toxicity was enhanced by induction chemotherapy. Overall survival outcomes were excellent for this condition. Continued use of this radiotherapy schedule is recommended as the platform for assessment of other chemotherapy schedules.     

Radiation pneumopathy. Our experience in the treatment of Hodgkin's disease with mantle-shaped field radiotherapy

The literature of the radiation pneumonitis is reviewed from the standpoint of the pathogenesis, histopathology and dependent parameters of the disease. A series of 125 patients treated with mantle fields for Hodgkin's disease between 1972/80 is studied. The radiation pneumonitis developed radiologically in 28 patients (22,4%); in 20 (72%) was asymptomatic. The incidence of pneumonitis against the time of onset of the disease, reveals a peak about the first three months after the end of radiotherapy. No significative variations of incidence of disease are seen in two groups of patients treated respectively with and without chemotherapy (20% and 26%). Frequency diagrams of pneumonitis as a function of the calculate values of the dose for TD, rets, TDF, show a significant correlation with the ranges of doses expressed in TDF.     

非小细胞肺癌三维适形放射治疗后急性放射性肺损伤分析

目的 探讨非小细胞肺癌(NSCLC)三维适形放射治疗后放射性肺损伤发生的相关因素,为提高NSCLC局部控制率和改善生存质量提供参考。方法 收集2000年8月至2004年12月符合入组条件接受三维适形放疗的非小细胞肺癌患者107例,其中全程三维适形放疗48例,59例前程行传统常规放疗,后程行三维适形放疗。全组患者均为根治性放疗,处方剂量60~78Gy,中位剂量66Gy。结果 全组患者放射性肺损伤发生率为62.6%,≥2级放射性肺损伤的发生率为38.3%,其中2级23例占21.5%,3级14例占13.1%,4级4例占3.7%。单因素分析显示,慢性阻塞性肺病、照射野个数、双肺接受的平均剂量、双肺V₅~V₄₀对≥2级放射性肺损伤的发生均有显著性影响,其中双肺平均剂量、双肺V₂₀、疗前伴慢性阻塞性肺病为影响放射性肺损伤发生的独立性因素。 结论 NSCLC接受三维适形放疗者,应严格限制双肺接受的平均剂量和双肺V₂₀,尤其对放疗前伴有慢性阻塞性肺病者更应高度重视避免严重放射性肺损伤的发生。     

Therapieinduzierte Effekte am Normalgewebe

More than 50% of cancer patients survive for more than 5 years, owing to modern and effective treatment. Therefore, long-term sequelae of treatment are more frequently seen than in the past. Such effects on normal tissue may both mimic and obscure tumor recurrences. Besides the direct consequences of surgery, tissue damage due to radiation or chemotherapy frequently cause problems in differential diagnosis. Among the numerous sequelae of radiotherapy, the most prominent are disturbance of the blood-brain barrier, radiation pneumonitis, osteodystrophy and osteoradionecrosis, fatty changes of bone marrow, or increased radiodensity of breast parenchyma. Chemotherapy may cause, e.g., diffuse abnormalities of white matter, pneumonitis and lung fibrosis, cardiomyopathy, or diffuse and patchy changes in bone marrow signals in MRI. The most devastating long-term complications are secondary cancers and leukemia induced by both radiotherapy and chemotherapy.