中肺合剂防治放射性肺炎的临床研究

[目的]评价中肺合剂防治放射性肺炎的临床疗效。[方法]2009年12月至2011年2月入组的83例肺癌患者随机分为两组,观察组42例给予三维适形或调强放射治疗同时口服中肺合剂,对照组41例仅行三维适形或调强放射治疗。根据RTOG放射性肺损伤标准进行评价,观察两组放射性肺炎出现时间、程度。[结果]观察组放射性肺炎发生率为21.42%（9/42）,对照组26.82%（11/41）,从放疗开始到出现放射性肺炎中位时间分别为80d和51d;其中观察组3、4级肺炎发生率为4.76%（2/42）,而对照组为21.95%（9/41）（P〈0.05）。观察组放射性肺纤维化发生率为7.14%（3/42）,对照组为24.39%（10/41）,统计学有显著性差异（P〈0.05）。[结论]中肺合剂能有效预防和推迟放射性肺炎的发生、降低3、4级放射性肺炎的发生率、减少放射性肺纤维化的发生,提高了患者的生活质量。     

热疗治疗急性放射性肺炎45例

[目的]分析热疗治疗急性放射性肺炎的疗效。[方法]急性放射性肺炎患者45例予常规治疗联合热疗（热疗组）,与同期仅予常规治疗45例（对照组）作对照比较。[结果]热疗组有效率（75．56％）明显高于对照组的有效率（46．67％）,两组有效率比较有统计学差异（P=0．018）。[结论]热疗组联合对症处理治疗急性放射性肺炎疗效好,可能成为治疗放射性肺炎的新途径。     

放射性肺炎患者血清C-反应蛋白（CRP）和体液免疫功能变化及意义

目的：探讨放疗后发生放射性肺炎患者血清CRP和体液免疫功能变化及意义。方法：用自动生化分析仪INMAGE测定血清CRP和免疫球蛋白IgG、Iga、IgM及补体3（C3）、补体4（CA．）量。放射治疗后同时间段,未发生放射性肺炎的肺癌患者作为对照组。结果：放射性肺炎和未发生放射性肺炎的患者血清中CRP分别为5．54±4．00和1．80±1．78,两者有显著差别（P〈0．001）,放射性肺炎的程度与血清CRP呈正相关（r=0．62,P〈0．01）,血清免疫球蛋白及补体两组间无显著差别。结论：放射性肺炎患者血清CRP明显升高,CRP对诊断放射性肺炎有一定的帮助。     

放射性肺损伤的高分辨率CT表现

目的：探讨放射性肺损伤的高分辨率ＣＴ（ＨＲＣＴ）特征。材料与方法：５６例经ＨＲＣＴ检查的放射性肺损伤患者,男５２例,女４例,采用双盲法阅片,总结放射性肺损伤ＨＲＣＴ征象,并与临床表现对比,进行回顾性分析。结果：（１）放射性肺损伤的发生与照射剂量成正相关,损伤的部位与照射野一致;（２）放射性肺损伤的临床表现与ＣＴ征角不平行,一般较ＣＴ片象不平行,一般较ＣＴ征象为轻。     

三乙醇胺保留灌肠对宫颈癌放射性肠炎的疗效

目的：探讨三乙醇胺保留灌肠在放射性肠炎中的疗效。方法：将79例不同程度放射性肠炎病人,随机分为实验组（三乙醇胺保留灌肠）和对照组（常规保留灌肠）,治疗后进行对比研究。结果：在放射性肠炎治疗中,实验组疗效明显高于对照组（P〈0.05）。结论：三乙醇胺保留灌肠对放射性肠炎能提高治愈率、缩短病程、极大地减轻病人痛苦,安全有效。     

生脉联合地塞米松治疗放射性肺炎的临床观察

目的：评价生脉联合地塞米松治疗放射性肺炎的疗效。方法30例确诊的放射性肺炎患者给予生脉和地塞米松。结果30例均可评价疗效,其中显效12例（40.0％）,有效15例（50.0％）,无效3例（10.0％）,总有效率为90.0％。结论生脉联合地塞米松治疗放射性肺炎安全有效。     

放射性^131I照射与分化型甲状腺癌细胞摄碘（^125I）率关系的实验研究

目的：探讨分化型甲状腺癌培养细胞接受放射性碘（^131I）照射剂量与摄取放射性碘间的相关性,为放射性碘去除治疗甲状腺癌提供新的思路.方法：设两个实验组,对分化型甲状腺癌细胞进行培养,其一应用同一活度（20μCi）的放射性^131I对培养细胞进行不同时间的照射,另组应用不同活度的放射性^131I对培养细胞进行相同时间（12h）的照射,分别测定两组甲状腺癌细胞摄取放射性^125I水平.结果：不同活度或不同时间的放射性^131I照射使甲状腺癌细胞摄取碘的水平降低,受照射组与未照射对照组细胞摄碘率比较有显著性差异（P＜0.01）.结论：放射性^131I照射可以使分化型甲状腺癌细胞摄碘率显著降低.     

芦荟联合重组人表皮生长因子防治鼻咽癌急性放射性皮炎的疗效观察

目的:探讨芦荟联合重组人表皮生长因子对鼻咽癌患者急性放射性皮炎的防治效果。方法:选取100例根治性放疗的鼻咽癌患者,随机分为两组。50例患者第1次放疗后涂抹重组人表皮生长因子及芦荟汁为实验组,50例仅涂抹芦荟汁为对照组。结果:实验组和对照组急性放射性皮炎发生率分别为48.0％、84.0％（P＜0.01）。I-Ⅱ级放射性皮炎发生率实验组为42.0%（21/50）,对照组为66.0%（33/50）。 Ⅲ-Ⅳ级放射性皮炎发生率实验组为6.0％(3／50),对照组为18.0％(9/50)。实验组疼痛评分较对照组低（P＜0.01）。放疗结束后随访4周,实验组患者91.7%（22/24）在1周内急性放射性皮炎病情缓解,对照组61.9%（26/42）的患者在1周内病情缓解。对照组急性放射性皮炎持续时间长于实验组（P＜0.05）。结论:芦荟联合重组人表皮生长因子防治鼻咽癌急性放射性皮炎效果良好,可减轻患者痛苦、改善生活质量,为鼻咽癌患者放疗顺利进行提供保障。     

单味龙血竭对急性放射性肠损伤的防护作用

目的:回顾性分析中药龙血竭预防急性放射性肠损伤的临床疗效。方法:2007年-2013年我院盆腔肿瘤术后放疗患者296例。预防组（157例）给予龙血竭胶囊口服（6～8粒/次,3次/d,与放疗同步）;对照组（139例）给予思密达口服（1包/次,3次/d,与放疗同步）。观察两组急性放射性肠损伤发生的时间、程度,并观察服用龙血竭后的不良反应发生情况。结果:预防组和对照组急性放射性肠损伤发生时间分别为放疗开始第12~30天（平均25天）和第2~35天（平均13天）,预防组发生时间明显晚于对照组。预防组和对照组急性放射性肠损伤总发生率、Ⅱ-Ⅳ级急性放射性肠损伤发生率分别为14.65%、32.37%和5.10%、15.83%,统计学分析均具有显著性差异（χ2=13.09,χ2=9.32,P＜0.01）。两组均未出现严重急性放射性肠损伤（Ⅳ级）。结论:龙血竭防治急性放射性肠损伤发生时间晚、发生率低、程度轻,临床预防效果满意。     

三乙醇胺乳膏防治急性放射性皮炎的疗效观察

目的：观察三乙醇胺乳膏预防急性放射性皮炎的临床效果。方法：将放射治疗的86例鼻咽癌和乳腺癌根治术或改良根治术后需行辅助性放射治疗的病人随机分为用药组（45例）和对照组（41例）。用药组在放射治疗开始即给予三乙醇胺乳膏涂擦,直至放疗结束,发生湿性皮炎后局部继续涂擦三乙醇胺乳膏;对照组保持照射野皮肤干燥、清洁,不予任何药物外涂,发生湿性皮炎后局部涂擦烫伤油。结果：用药组Ⅱ级及以上急性放射性皮炎的发生率明显低于对照组（ P＜0.05）,存在统计学差异。对照组有1例发生Ⅳ级急性放射性皮炎,而用药组无Ⅳ级急性放射性皮炎发生。且用药组急性放射性皮炎发生时间明显晚于对照组,差异有统计学意义（P＜0.05）。同时用药组明显缩短急性放射性皮炎愈合时间（P＜0.05）。结论：三乙醇胺乳膏能有效地防治急性放射性皮炎。     

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.     

Dose de tolérance à l’irradiation des tissus sains : le poumon

Radiation pneumonitis is the most common dose limiting complication of thoracic radiation. Clinically significant radiation pneumonitis usually develops in 10–20% of patients. Characteristic clinical features associated with radiation pneumonitis include dyspnea, non-productive cough, radiographic opacification confined to the outlines of the field of radiation treatment and changes in pulmonary function measures. The risk of radiation pneumonitis is related to the cumulative dose of radiation to normal tissue and to patients and tumor features. Some studies demonstrated that preexisting pulmonary lung dysfunction, tumour location in lower lobes, use of concurrent chemotherapy could increase the risk of radiation pneumonitis. Controversies persist about which dosimetric parameter optimally predicts the risk of radiation pneumonitis. Mean lung dose, V20 and V30 are the most studied parameters. However, no ideal dosimetric parameter has been identified. The objective of this review is to summarize predictive factors of radiation pneumonitis, and to evaluate the predictive ability of various dose–volume histogram parameters for routine practice.     

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.     

Nivolumab-induced radiation recall pneumonitis in non-small-cell lung cancer patients with thoracic radiation therapy

The role of previous thoracic radiation therapy as a risk factor of immune-related pneumonitis is unclear. Furthermore, some patients develop radiation recall pneumonitis, which is characterized by a radiation pneumonitis-like imaging pattern with consolidation progressing within a previous radiation field. In this multicenter retrospective study, we analyzed the relationship of previous thoracic radiation therapy with immune-related pneumonitis and the characteristics of radiation recall pneumonitis. The medical records of patients with non-small-cell lung cancer who had received nivolumab between December 2015 and March 2017 at five institutions were retrospectively reviewed. Incidence, imaging patterns, clinical course, and risk factors of immune-related pneumonitis and radiation recall pneumonitis were evaluated. A total of 669 patients were evaluated, and the incidences of all-grade and grade 3 or higher immune-related pneumonitis were 8.8% and 2.6%, respectively. The incidences of immune-related pneumonitis were 13.2% (34/257) and 6.1% (25/412) in patients with and those without previous thoracic radiation therapy, respectively. A history of previous thoracic radiation therapy was associated with immune-related pneumonitis (odds ratio, 2.11; 95% confidence interval, 1.21–3.69 in multivariate analysis). Among the patients with previous thoracic radiation therapy, 6.2% (16/257) showed radiation recall pattern. This study found an increased risk of nivolumab-induced immune-related pneumonitis associated with a history of thoracic radiation therapy. Radiation recall pattern was one of the major patterns of immune-related pneumonitis among the patients with previous thoracic radiation therapy. Incidence, risk factors, and clinical outcome of radiation recall pneumonitis were elucidated.     

Risk factors for severe radiation pneumonitis in lung cancer.

BACKGROUND: Risk factors for severe radiation pneumonitis, which often spreads beyond treatment portals and may even be bilateral, have not been fully investigated. The purpose of this study was to identify important factors associated with severe radiation pneumonitis. METHODS: 111 cases of primary lung cancer, treated with radiotherapy or chemoradiotherapy, were retrospectively analyzed. RESULTS: Severe radiation pneumonitis occurred in 17 cases (15.3%). The ratio of interstitial change in lungs before radiotherapy and radiotherapy to the contralateral mediastinum with > 40 Gy in the radiation pneumonitis group (RP group) was significantly higher than in patients without radiation pneumonitis (control group) (47.1% vs 5.3%; P < 0.001 and 58.8% vs 27.7%; P = 0.037, respectively). Using logistic regression analysis, interstitial changes before radiotherapy and radiotherapy to the contralateral mediastinum of > 40 Gy were significant risk factors associated with severe radiation pneumonitis. CONCLUSIONS: These data suggest that pre-existing interstitial changes detected by chest radiography or computed tomography and radiotherapy to the contralateral mediastinum (> 40 Gy) may predict the development of severe radiation pneumonitis.     

非小细胞肺癌低分割放疗后放射性肺炎的影响因素分析

目的 探讨非小细胞肺癌低分割放疗后放射性肺炎的影响因素.方法 收集120例接受低分割放疗的非小细胞肺癌患者的临床资料,对术后3个月内发生放射性肺炎的危险因素进行Logistic回归分析.结果120例患者中,37例(30.83%)患者发生放射性肺炎,83例(69.17%)患者未发生放射性肺炎.有肺部疾病史、肿瘤体积≥40 cm3、V20≥12%、患肺最大受照剂量≥54 Gy、有化疗史是影响非小细胞肺癌低分割放疗后放射性肺炎的独立危险因素(P﹤0.05).结论 非小细胞肺癌低分割放疗后放射性肺炎的发生是各项指标相互作用的结果,在制定放疗计划时需综合考虑各项指标,及时调整治疗方案以降低放射性肺炎的发生率.     

Circulating IL-6 as a predictor of radiation pneumonitis

PURPOSE: We report results from a clinical research protocol investigating circulating pro-inflammatory cytokines (interleukin-6 [IL-6] and tumor necrosis factor alpha [TNFalpha]) in relation to radiation pulmonary injury. METHODS AND MATERIALS: In a protocol for cytokine measurement, 25 patients had clinical follow-up longer than 12 months, and 24 had serial cytokine data. Serial plasma specimens before, during, and after thoracic radiotherapy were analyzed for IL-6 and TNFalpha using enzyme-linked immunosorbent assay (ELISA). Radiation pulmonary injury was defined using National Cancer Institute Common Toxicity Criteria. RESULTS: Of the 24 patients, 6 had Grade 1 pneumonitis, and 13 had Grade 2 pneumonitis. There was no Grade 3/4 pneumonitis. Median time of radiation pneumonitis was between 8 and 12 weeks post-therapy. IL-6 levels before, during, and after thoracic radiation therapy were significantly higher in those who developed pneumonitis. In contrast, we did not detect a significant correlation between plasma TNFalpha and radiation pneumonitis. CONCLUSIONS: High pretreatment plasma levels of IL-6 predisposed patients to the risk of radiation pneumonitis. Pretreatment IL-6 level may serve as a predictor for radiation pneumonitis. Serial plasma IL-6 was consistently higher for the pneumonitis group. The role of IL-6 in the cytokine cascades that promote radiation pulmonary injury deserves further investigation.     

Early variations of circulating interleukin-6 and interleukin-10 levels during thoracic radiotherapy are predictive for radiation pneumonitis.

PURPOSE: To investigate variations of circulating serum levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNFalpha), and interleukin-10 (IL-10) during three-dimensional conformal radiation therapy (3D-CRT) in patients with non-small-cell lung cancer and correlate these variations with the occurrence of radiation pneumonitis. PATIENTS AND METHODS: Ninety-six patients receiving 3D-CRT for stage I to III disease were evaluated prospectively. Circulating cytokine levels were determined before, every 2 weeks during, and at the end of treatment. Radiation pneumonitis was evaluated prospectively between 6 and 8 weeks after 3D-CRT. The predictive value of clinical, dosimetric, and biologic (cytokine levels) factors was evaluated both in univariate and multivariate analyses. RESULTS: Forty patients (44%) experienced score 1 or more radiation pneumonitis. No association was found between baseline cytokine levels and the risk of radiation pneumonitis. In the whole population, mean levels of TNFalpha, IL-6, and IL-10 remained stable during radiotherapy. IL-6 levels were significantly higher (P = .047) during 3D-CRT in patients with radiation pneumonitis. In the multivariate analysis, covariations of IL-6 and IL-10 levels during the first 2 weeks of 3D-CRT were evidenced as independently predictive of radiation pneumonitis in this series (P = .011). CONCLUSION: Early variations of circulating IL-6 and IL-10 levels during 3D-CRT are significantly associated with the risk of radiation pneumonitis. Variations of circulating IL-6 and IL-10 levels during 3D-CRT may serve as independent predictive factors for this complication.     

107例NSCLC患者放疗后≥2级放射性肺炎预测模型的建立和分析

目的 探讨非小细胞肺癌三维适形放疗后放射性肺炎发生的相关因素并建立数学预测模型.方法 收集行三维适形放疗的非小细胞肺癌患者107例.全组患者均为根治性放疗,剂量采用常规放疗,分割方式为2Gy/f,处方剂量60 ～78 Gy,中位剂量66 Gy.不同组别患者放射性肺炎的发生情况单因素分析采用x2检验.Logis-tic回归分析筛选影响放射性肺炎发生的独立预后因素.受试者工作特征(receiver operating characteristic,ROC)曲线分析评价其临床诊断性能.结果 本组患者放射性肺炎发生率为62.6％,≥2级放射性肺炎的发生率为38.3％,其中2级23例(21.5％),3级14例(13.1％),4级4例(3.7％).单因素分析结果显示,放射性肺炎的发生在慢性阻塞性肺疾病、T分期、射野数目、临床靶区(clinical target volume,CTV)的体积、CTV的平均剂量、计划靶区(planning target volume,PTV)体积、PTV的平均剂量、双肺体积和双肺Dmean、V5、V10、V15、V20、V25、V30、V35、V40方面差异均具有统计学意义(均P＜0.05).多因素分析显示,T分期、双肺Dmean、V20、V40为影响≥2级放射性肺炎发生的独立因素(均P＜0.05).在此基础之上,建立放射性肺炎的预测模型为Y=ex/(1+ex),其中x=-5.797-0.986×T分期+1.193×肺平均剂量+1.259 × V20+ 1.329×V40.结论 T分期、双肺Dmean、V20和V40为影响接受三维适形放疗的非小细胞肺癌患者发生≥2级放射性肺炎发生的独立因素,建立的数学预测模型对这类患者≥2级放射性肺炎的发生有较好的预测价值.     

食管癌放疗致放射性肺炎的临床分析

目的 探讨食管癌放疗后引起放射性肺炎的相关因素.方法 回顾性分析113例放疗后食管癌患者,观察放疗的病变部位、年龄、治疗方案、受照剂量、肺病史和吸烟史与放射性肺炎发生率的关系.结果 发生放射性肺炎16例,其与病变部位、受照剂量及肺病史有关(P＜0.05),与年龄、吸烟及常规放射治疗和IMRT治疗方法关系不大.结论 病变...