Bronchiolitis obliterans organizing pneumonia syndrome in breast-conserving therapy for early breast cancer: Radiation-induced lung toxicity
Bronchiolitis obliterans organizing pneumonia syndrome in breast-conserving therapy for early breast cancer: Radiation-induced lung toxicity
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DOI：
10.1016/s0360-3016(00)00654-4
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发表时间：
2000-10-01
影响因子：
7
通讯作者：
Takashima, S
中科院分区：
文献类型：
--
作者：
Takigawa, N;Segawa, Y;Takashima, S
目的：保乳手术和术后放疗在早期乳腺癌的治疗中起着重要作用。闭塞性毛细支气管炎组织肺炎（BOOP）综合征最近被报道为辅助放疗的并发症之一。本研究的目的是确定乳腺癌患者BOOP综合征的发生率及其危险因素。方法与材料：1996年1月至1998年12月，157例乳腺癌保乳手术后行放疗。诊断大便综合征的标准如下：1)12个月内乳房放射治疗，2)一般和/或呼吸道症状持续至少2周，3)放射口外肺部浸润，4)没有特定原因的证据。结果：4例（2.5%）患者出现BOOP综合征，患者在放疗后5 ~ 6个月期间出现发热和非干咳，胸片上出现斑片状浸润影。泼尼松治疗（40 mg/天）可迅速改善症状和肺部浸润，并在2至5个月期间逐渐减少。然而，所有病例在减量期或停止强的松治疗后，BOOP综合征复发。支气管肺泡灌洗液中嗜酸性粒细胞和中性粒细胞计数升高，CD4+ / CD8+淋巴细胞比值升高。在有和没有BOOP综合征的患者中，年龄、放疗部位、他莫昔芬和/或化疗的使用或放疗剂量的患者比例没有差异。结论：乳房放射治疗后BOOP综合征被认为是一种难治性肺毒性。由嗜酸性粒细胞、中性粒细胞和淋巴细胞介导的免疫反应可能是导致这种综合征的原因。建立预防大便综合征的方法。(C) 2000 Elsevier Science Inc.；
Purpose: Breast-conserving surgery and postoperative radiotherapy have played important roles in the treatment of early breast cancer. Bronchiolitis obliterans organizing pneumonia (BOOP) syndrome has recently been reported to be one of the complications of adjuvant radiotherapy. The purpose of this study was to determine the incidence of and risk factors for BOOP syndrome in breast cancer patients.Methods and Materials: Between January 1996 and December 1998, 157 patients with breast cancer underwent radiotherapy after breast-conserving surgery. The criteria used for the diagnosis of POOP syndrome were as follows: 1) radiation therapy to the breast within 12 months, 2) general and/or respiratory symptoms lasting for at least 2 weeks, 3) radiographic lung infiltrates outside the radiation port, and 4) no evidence of a specific cause.Results: BOOP syndrome developed in 4 (2.5%) patients, who had fever and nonproductive cough, with patchy infiltrative shadows on chest roentgenograms which emerged between 5 and 6 months after radiotherapy. The symptoms and pulmonary infiltrates were rapidly improved by treatment with prednisone (40 mg/day), which was tapered over 2- to 5-month periods. However, BOOP syndrome relapsed in all cases during the tapering period or after withdrawal of prednisone. The eosinophil and neutrophil counts were increased and the ratios of CD4+ to CD8+ lymphocytes were elevated in bronchoalveolar lavage fluid in all four cases. There were no differences in proportions of patients by age, irradiated breast site, use of tamoxifen and/or chemotherapy, or radiation dose between those with and without BOOP syndrome.Conclusions: BOOP syndrome is considered an intractable form of lung toxicity after radiotherapy to the breast. An immunologic reaction mediated by eosinophils, neutrophils, and lymphocytes may be responsible for the development of this syndrome. Methods of prevention of POOP syndrome should be established. (C) 2000 Elsevier Science Inc.