影响放射性肺炎发生的相关因素分析

目的探讨照射剂量、照射野面积大小与放射性肺炎发生的关系。方法502例应用放射治疗的肺癌患者按照射剂量、照射野面积的大小分组,比较放射性肺炎的发生率。结果照射剂量DT<6000 cGy6、000~7000 cGy、>7000 cGy,放射性肺炎的发生率分别为3.41%、9.18%、36.4%(P<0.05)。照射野面积>160 cm2、<160 cm2,放射性肺炎的发生率分别为34.4%、7%(P<0.05)。结论照射剂量、照射野面积的大小是影响放射性肺炎发生的重要因素。     

106例放射性肺炎相关因素分析

目的 回顾性分析肺癌放射治疗后并发放射性肺炎的发生率,了解发生的相关因素.方法自1995年1月～2004年12月期间我科收治的793例肺癌病人.采有钴60或直线加速器6-10 MV X线外照射,常规分割,DT4 600 CGY-7 200 CGY/23～36 F.照射野面积大于120 cm2 547例.剂量大于5 000 CGY的680例.结果放射性肺炎发生率为13.4%.照射野面积大于120 cm2,剂量大于5 000 CGY的放射性肺炎发生率分别为16.2%和14.6%.结论放射治疗引起的放射损伤应引起高度重视,照射野面积大,剂量高,放射性肺炎的发生率高.     

放射性肺炎影响因素的多元回归分析

目的探讨放射性肺炎发生的影响因素,以指导肺癌治疗计划的制定,避免和减少正常肺组织的放射损伤.方法选取101例放射性肺炎患者,研究照射剂量等20个因素与放射性肺炎的关系.应用SPSS*!8.0进行χ2检验的单因素分析、Logistic多元回归分析筛选影响因素.结果①单因素分析显示肺部感染、肺不张、阻塞性肺炎、胸水、心血管疾患、慢性支气管炎史、化疗史、照射剂量、照射天数、照射野大小10个因素与放射性肺炎的发生有关.②多因素研究发现肺部感染、阻塞性肺炎、肺不张、胸水、慢性支气管炎史、心血管疾患、化疗史、照射剂量、照射野大小9个因素为放射性肺炎发生的独立影响因素.结论在制定肺癌放射治疗计划时,充分考虑患者的合并症、化疗史、照射剂量、照射野大小等因素,可减少放射性肺炎的发生机会.     

乳腺癌术后放疗诱发放射性肺炎的探讨

目的:分析乳腺癌术后放疗诱发放射性肺炎的临床资料,探讨放疗设野的临床意义.方法:1997至1999年122例乳腺癌患者行胸壁切线、锁骨上野照射,部分行内乳野、腋锁野照射.结果:放射性肺炎多发生在行腋锁野照射的患者.结论:放射性肺炎的发生与腋锁野照射和照射的体积有关,放射时应尽量减少肺的照射体积.     

乳腺癌术后放疗诱发放射性肺炎的探讨

目的：分析乳腺癌术后放疗诱发放射性肺炎的临床资料,探讨放疗设野的临床意义。方法：1997年至1999年122例乳腺癌患者行胸壁切线、锁骨上野照射,部分行内乳野、腋锁野照射。结果：放射性肺炎多发生在行腋锁野的患者。结论：放射性肺炎的发生与腋锁野照射和照射的体积有关,放射时应尽量减少肺的照射体积。     

影响放射性肺炎发生的相关因素分析

目的探讨照射剂量、照射野面积大小与放射性肺炎发生的关系。方法502例应用放射治疗的肺癌患者按照射剂量、照射野面积的大小分组，比较放射性肺炎的发生率。结果照射剂量DT＜6000cGy、6000-7000cGy、＞7000cGy，放射性肺炎的发生率分别为3．41％、9．t8％、36．4％（P＜0．05）。照射野面积＞160cm^2、＜160cm^2，放射性肺炎的发生率分别为34．4％、7％（P＜0．05）。结论照射剂量、照射野面积的大小是影响放射性肺炎发生的重要因素。     

早期乳腺癌保乳术后部分乳腺三维适形外照射的远期观察

目的 探讨中国女性早期乳腺癌保乳术后部分乳腺三维适形外照射的可行性、疗效及美容效果。方法 2003—2010年44例早期乳腺癌患者接受保乳术后部分乳腺外照射,其中 20例ABC辅助适度深吸气下CT模拟定位,24例自由呼吸下CT模拟定位。采用4个非共面野行三维适形照射,3.40 Gy/次者 39例,3.85 Gy/次者 5例,照射2 次/d(间隔至少6 h)并连续照射5 d。结果 随访时间满2、3、5年者分别为39、31、16例。放疗结束后3个月只有 17例发生1级放射性皮炎(39%)。放疗后6个月和 2年乳房美容效果优良率分别为100%和95%。放疗后2、3、5年局部控制率分别为100%、99%、94%,生存率均为100%。结论 符合条件的中国女性早期乳腺癌患者保乳术后行部分乳腺外照射是可行的,急性放射反应低,可获得满意的美容效果和远期疗效。     

不同照射野三维适形放疗在局部晚期非小细胞肺癌中的应用

目的:分析不同照射野三维适形放疗在局部晚期非小细胞肺癌中的应用价值.方法: 回顾性分析2005年1月至2008年6月收治的132例局部晚期非小细胞肺癌患者资料,均行三维适形放疗,依据照射野的不同,分成3野组与5野组,常规分割进行照射,5次/周,DT60Gy-66Gy/30f-33f.观察两组患者近期疗效、V30、V20、V15、V10、V5等参数以及放射性肺炎的发生,并进行比较.结果: 两组患者之间近期疗效(CR+PR)、V20、放射性肺炎的发生均无差异(P>0.05);3野组V30、V15、V10高,而5野组V5较高,V30、V10、V5具有非常显著差异(P<0.01),V15具有显著差异(P<0.05).结论: 采用3野或5野进行照射,效果相似.     

肺癌放疗与放射性肺炎的研究

目的分析肺癌放射治疗后的放射性肺炎发生的因素,提供今后对策.方法以我院412例肺癌放射治疗患者资料,分析照射剂量、设野面积及发生时间等项目,发生率以X2检验.结果放射性肺炎的发生率8.25%,单纯放疗为7.71%,化疗加放疗为10.6%,二者无差异(P＞0.05),14～67天内发生,放疗过程中发生4例,一般在两个月内.放疗剂量≥70Gy,放射性肺炎发生率为15.38%,50～70Gy为9.32%,＜50Gy为1.33%,呈剂量反应(P＞0.05).设野面积≥180cm2放射性肺炎发生率为11.76%,明显高.结论放射性肺炎是肺癌放疗中严重的并发症,其预防首先应根据患者情况设计治疗方案,设野可实行后缩野、多野、超分割或适形放疗.对有肺部疾患的要积极治疗,发生时要及时处理,剂量控制还是可降低放射性肺炎的发生率.     

乳腺癌术后放疗致放射性肺炎的临床分析

目的 探讨乳腺癌术后放疗引起放射性肺炎的相关临床因素.方法 回顾性分析226例术后放疗的乳腺癌,观察放疗的照射野、照射剂量,使用化疗药物的时间、种类,内分泌治疗,患者的年龄和肺部基础病变与放射性肺炎发生率的关系.结果 发生放射性肺炎29例,放射性肺炎的发生率与照射野、照射剂量和使用化疗药物的时间有关(P<0.05),与化疗药物种类和肺部基础病变也有一定关系.结论 照射野和剂量的增加、放疗前化疗及肺部基础病变均会增加放射性肺炎的发生率.     

Analysis of radiation pneumonitis and radiation-induced lung fibrosis in breast cancer patients after breast conservation treatment

We examined radiation pneumonitis in breast cancer patients after breast conservation treatment (BCT) and analysed the degree of radiation-induced lung fibrosis by computed tomographies of the chest (chest CT). Fifty-two breast cancer patients were treated with BCT, including breast irradiation and chemotherapy. These patients symptomatic of radiation pneumonitis were examined every two to four weeks. Chest X-rays and chest CT were performed about one year after irradiation. symptoms due to radiation pneumonitis was registered in 9.6% of patients. lungs showed fibrotic changes by chest CT in 90% of the cases. Concurrent or alternative chemotherapy increased the incidence of symptomatic radiation pneumonitis and, to a certain extent, the degree of fibrotic change in the lung after BCT.     

肺灌注显像检查预测肺癌放射性肺损伤的价值

目的探讨肺癌患者肺灌注显像的特点及其放射治疗过程中的变化,观察其与放射性肺损伤发生的关系。方法31例接受根治性放疗的肺癌患者接受了肺灌注显像检查,其中8例仅在放疗前接受了此项检查。以照射前后计算区域的肺灌注平均计数值占相应全肺平均计数值的百分比,比较照射前后肺灌注的变化。放射性肺损伤的评价按美国肿瘤放射治疗组（RTOG）急性放射性肺炎标准评定。结果31例患者中,中央型22例,周围型9例。病理类型：鳞癌12例,腺癌1例,小细胞肺癌15例,未分型3例。Ⅰ、Ⅱ期8例,Ⅲa期9例,Ⅲb期14例。行适形放疗26例,常规放疗5例;照射剂量32—72Gy,中位剂量58Gy。6例发生2级或3级放射性肺炎,无放射性肺炎死亡病例。全部患者治疗前均有不同程度的灌注受损,中央型肺癌患者灌注受损范围≥2级者占68．2％（15／99）,而周围型仅占22．2％（2／9,P=0．04）。受损范围为1级和2级以上者,分别有40．0％（6／15）和37．5％（6／16）的患者发生2级以上放射性肺损伤。在两次行肺灌注检查的23例中,肺灌注受损有所改善者占70．0％（16／23）,其中2级以上放射性肺炎发生率为31．3％（5／16）;在肺灌注受损加重者中,2级以上放射性肺炎发生率为42．9％（3／7）。结论灌注受损是肺癌患者的常见表现,中央型肺癌灌注受损较重,放射治疗后多数病例肺灌注受损有所改善;放疗前和放疗中,肺灌注受损范围的变化和放射性肺损伤的发生无明显相关性。     

Risk of pneumonitis in breast cancer patients treated with radiation therapy and combination chemotherapy with paclitaxel.

BACKGROUND: Some chemotherapy (CT) drugs, including taxanes, may enhance the effectiveness of radiation therapy (RT). However, combining these therapies may increase the incidence of radiation pneumonitis, a lung inflammation. In a retrospective cohort study, we evaluated the incidence of radiation pneumonitis in breast cancer patients treated with RT and standard adjuvant CT by use of doxorubicin (Adriamycin) and cyclophosphamide, with and without paclitaxel. METHODS: Forty-one patients with breast cancer were treated with RT and adjuvant CT, including paclitaxel. Paclitaxel and RT (to breast-chest wall in all and lymph nodes in some) were delivered sequentially in 20 patients and concurrently in 21 patients. Paclitaxel was given weekly in some patients and every 3 weeks in other patients. The incidence of radiation pneumonitis was compared with that among patients in our database whose treatments did not include paclitaxel (n = 1286). The percentage of the lung volume irradiated was estimated. The Cox proportional hazards model was used to find covariates that may be associated with the observed outcomes. All P values were two-sided. RESULTS: Radiation pneumonitis developed in six of the 41 patients. Three patients received paclitaxel concurrently with RT, and three received it sequentially (P =.95). The mean percentage of lung volume irradiated was 20% in patients who developed radiation pneumonitis and 22% in those who did not (P =.6). For patients treated with CT including paclitaxel, the crude rate of developing radiation pneumonitis was 14.6% (95% confidence interval [CI] = 5.6% to 29.2%). For patients treated with CT without paclitaxel, the crude rate of pneumonitis was 1.1% (95% CI = 0.2% to 2.3%). The difference between the crude rates with or without paclitaxel is highly statistically significant (P<.0001). The mean time to develop radiation pneumonitis in patients treated concurrently with RT and paclitaxel was statistically significantly shorter in patients receiving paclitaxel weekly than in those receiving it every 3 weeks (P =.002). CONCLUSIONS: The use of paclitaxel and RT in the primary treatment of breast cancer should be undertaken with caution. Clinical trials with the use of combination CT, including paclitaxel plus RT, whether concurrent or sequential, must evaluate carefully the incidence of radiation pneumonitis.     

肺灌注显像联合剂量体积直方图参数预测放射性肺炎的临床研究

 目的　观察接受三维适形或调强放疗的肺癌患者放疗前后肺灌注显像的变化、肺受照射的剂量体积直方图（DVH）参数等,并结合临床因素,探讨其与放射性肺炎发生的相关性。方法　18例接受三维适形或调强放疗的肺癌患者放疗前后行肺灌注显像检查,比较照射前后肺灌注显像的变化。放射性肺炎的评价按美国肿瘤放疗协作组（RTOG）急性放射性肺炎标准评定。获得的CT与单光子发射CT（SPECT）肺灌注图像融合后,将等剂量曲线投影到SPECT图像,将传统的DVH转换成f-DVH。将f-DVH曲线中每例患者的V5、V10和V20所对应的灵敏度与特异度相加,取其最大值,寻找到曲线的界值。分析放疗前后肺灌注显像变化及肺受照射的DVH与放射性肺炎发生的相关性。结果　18例患者中,33.3 %（6／18）发生了2级以上放射性肺炎。放疗前后肺灌注受损加重者2级以上放射性肺炎发生率为62.5 %（5／8）,肺灌注受损改善者发生率为10.0 %（1／10）。f-DVH图曲线中V5、V10和V20的界值分别为53 %、41 %和27 %,以V5对中重度急性放射性肺炎的预测准确度最高。放疗前后肺灌注显像的变化联合全肺DVH参数V5是放射性肺炎最强的预测因素。结论　肺癌患者放疗前后肺灌注显像能反映患侧肺灌注功能的变化。放疗前后肺灌注显像的变化联合DVH参数V5有望作为预测放射性肺炎发生的指标。     

A case of metachronous bilateral Breast Cancer with bilateral radiation pneumonitis after breast-conserving therapy

We report a patient with metachronous bilateral breast cancer who has twice developed radiation pneumonitis after breast-conserving therapy for each breast. The patient was a 48-year-old woman, who presented with Stage I right breast cancer. After wide excision of the right breast tumor and dissection of level I axillary lymph nodes, systemic therapy with oral 5-FU and tamoxifen was started. Subsequently, tangential irradiation with a total dose of 50 Gy in 25 fractions was given. Seven months after irradiation, she developed respiratory symptoms and radiation pneumonitis was diagnosed. The symptoms resolved with oral prednisolone. Thirty months after the right breast cancer treatment, Stage I left breast cancer was diagnosed. After wide excision of the left breast tumor and partial removal of the level I axillary lymph nodes, the same oral systemic chemo-hormonal therapy was initiated. Thereafter, tangential irradiation with a total dose of 50 Gy in 25 fractions was given. Four months after irradiation, she developed respiratory symptoms. A chest X-ray showed an area of increased density in the left lung consistent with radiation pneumonitis. The symptoms were mild and they improved spontaneously without medication. Although there is insufficient evidence to justify or withhold whole breast radiation therapy from patients with a history of contralateral breast cancer and radiation pneumonitis, it is essential to discuss the adequacy of whole breast irradiation and the possibility of alternative approaches, such as breast-conserving surgery without irradiation or partial breast irradiation for this rare condition.     

Radiation pneumonitis in breast cancer patients treated with conservative surgery and radiation therapy

The likelihood of radiation pneumonitis and factors associated with its development in breast cancer patients treated with conservative surgery and radiation therapy have not been well established. To assess these, we retrospectively reviewed 1624 patients treated between 1968 and 1985. Median follow-up for patients without local or distant failure was 77 months. Patients were treated with either tangential fields alone (n = 508) or tangents with a third field to the supraclavicular (SC) or SC-axillary (AX) region (n = 1116). Lung volume treated in the tangential fields was generally limited by keeping the perpendicular distance (demagnified) at the isocenter from the deep field edges to the posterior chest wall (CLD) to 3 cm or less. Seventeen patients with radiation pneumonitis were identified (1.0%). Radiation pneumonitis was diagnosed when patients presented with cough (15/17, 88%), fever (9/17, 53%), and/or dyspnea (6/17, 35%) and radiographic changes (17/17) following completion of RT. Radiographic infiltrates corresponded to treatment portals in all patients, and in 12 of the 17 patients, returned to baseline within 1-12 months. Five patients had permanent scarring on chest X ray. No patient had late or persistent pulmonary symptoms. The incidence of radiation pneumonitis was correlated with the combined use of chemotherapy (CT) and a third field. Three percent (11/328) of patients treated with a 3-field technique who received chemotherapy developed radiation pneumonitis compared to 0.5% (6 of 1296) for all other patients (p = 0.0001). When patients treated with a 3-field technique received chemotherapy concurrently with radiation therapy, the incidence of radiation pneumonitis was 8.8% (8/92) compared with 1.3% (3/236) for those who received sequential chemotherapy and radiation therapy (p = 0.002). A case:control analysis was performed to determine if the volume of lung irradiated (as determined using central lung distance [CLD]) was related to the risk of developing radiation pneumonitis. Three control patients were matched to each case of radiation pneumonitis based on age, side of lesion, chemotherapy (including sequencing), use of a third field, and year treated. Lung volumes were similar in the radiation pneumonitis cases and controls. We conclude that radiation pneumonitis following conservative surgery and radiation therapy for breast cancer is a rare complication, and that it is more likely to occur in patients treated with both a 3-field technique and chemotherapy (particularly given concurrently with radiation therapy). Over the limited range of volumes treated, lung volume was not associated with an increased risk of radiation pneumonitis.     

Carboplatin (JM8), etoposide (VP16) and thoracic irradiation for small cell lung cancer (S.C.L.C.): an evaluation of lung toxicity

Carboplatin (JM8) and etoposide (VP16) have demonstrated activity against a range of solid tumours. A retrospective study has looked for evidence of enhanced radiation pneumonitis when these drugs are employed in conjunction with irradiation. Twenty-nine patients with limited disease small cell lung cancer (S.C.L.C.) received JM8 (300 mg/m2) and VP16 (300 mg/m2) at intervals of 3-4 weeks for 4 cycles followed by thoracic irradiation. Twenty-one were evaluated and compared with 21 matched non-S.C.L.C. patients treated by radiotherapy alone. Patients were stratified into three groups according to the radiation dose schedule normalised using Wara's modification of Ellis' formula (n = 0.38, t = 0.06) [28]. Group 1 received less than 1014 rets, Group 2 1015-1250 rets and Group 3 greater than 1250 rets. Radiological pneumonitis was observed in 57% (12/21) of patients receiving combined modality treatment compared to 71% (15/21) of patients receiving radiation alone with evidence of a radiation dose-response relationship for the appearance of pneumonitis in both groups of patients (p greater than 0.1). In conclusion, no enhancement of radiation pneumonitis by carboplatin (JM8) or etoposide (VP16) has been observed.     

Outcome and prognostic factors for patients with non-small-cell lung cancer and severe radiation pneumonitis

PURPOSE: Radiation pneumonitis is a serious complication that develops after thoracic irradiation. The purpose of this study was to identify prognostic factors for severe radiation pneumonitis in patients with non-small-cell lung cancer. METHODS AND MATERIALS: The medical records of patients with non-small-cell lung cancer and severe radiation pneumonitis were reviewed. Variables were analyzed by univariate and stepwise multivariate analysis using the Cox regression model. RESULTS: Among the 31 patients, the mortality rate approached 50% in the first 2 months after the onset of radiation pneumonitis. The variables significantly associated with survival in the univariate analysis were tumor histologic feature, grade and extent (out-of-field or in-field) of radiation pneumonitis, oxygenation index, and serum albumin (<35 g/L or >or=35 g/L), and uric acid levels at the onset of radiation pneumonitis. Only the extent of radiation pneumonitis and serum albumin level were independently associated with survival in the multivariate analysis. CONCLUSION: The mortality rate of non-small-cell lung cancer patients with severe radiation pneumonitis is extremely high, and survival is much shorter in patients with out-of-field radiation pneumonitis or a low serum albumin level at the onset. Additional studies to investigate the factors precipitating out-of-field radiation pneumonitis should improve the management of irradiation complications.     

糖尿病与放射性肺炎发生的相关危险性分析

目的 探讨伴有糖尿病的肺癌患者在接受放射治疗后放射性肺炎的发生情况.方法 156例非小细胞肺癌(NSCLC)患者均接受三维适形放射治疗,其中伴有糖尿病者52例,无糖尿病的对照组104例,随访观察1年,比较两组患者放射性肺炎的发生情况,并分析血糖控制水平和糖尿病病史与放射性肺炎的发病相关性.结果 糖尿病组和对照组患者放射性肺炎的发病率分别为40.4%和21.2%.(P<0.05),伴有糖尿病的肺癌患者放射性肺炎的发病危险是对照组患者的2.05倍(95%CI为1.17～3.58).糖尿病组和对照组患者放射性肺炎的严重程度无明显差异.血糖控制较好的NSCLC患者放射性肺炎的发病率(30.6%)低于血糖控制欠佳者(62.5%,P<0.05).糖尿病病史较长的NSCLC患者与糖尿病病史较短者比较,放射性肺炎的发病率差异无统计学意义(P0.05).结论 糖尿病为NSCLC患者发生放射性肺炎的易感因素,其易感程度与血糖控制水平有关.