Renin-Angiotensin System Inhibitors Might Help to Reduce the Development of Symptomatic Radiation Pneumonitis After Stereotactic Body Radiotherapy for Lung Cancer
Renin-Angiotensin System Inhibitors Might Help to Reduce the Development of Symptomatic Radiation Pneumonitis After Stereotactic Body Radiotherapy for Lung Cancer
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DOI：
10.1016/j.cllc.2015.08.007
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发表时间：
2016-05-01
影响因子：
3.6
通讯作者：
Osti, Mattia F.
中科院分区：
文献类型：
--
作者：
Bracci, Stefano;Valeriani, Maurizio;Osti, Mattia F.
使用肾素-血管紧张素系统（RAS）抑制剂可能会预防肺部肿瘤放疗后出现症状性放射性肺炎（RP）。立体定向全身放射治疗（SBRT）通常用于不适合手术的患者；然而，由于大多数患者年龄较大和/或患有合并症，因此可能无法耐受。 RAS抑制剂的使用与肺部病变SBRT后减少≥2级RP的发生有关。 简介：本研究的目的是评估肾素-血管紧张素系统（RAS）抑制剂在预防立体定向全身放疗（SBRT）后症状性放射性肺炎（RP）中的作用。材料和方法：回顾性分析2008年12月至2014年7月期间接受1至3次SBRT治疗的158例孤立性肺病灶患者的数据。根据不良事件通用毒性标准第 4 版评估 RP 的发生率。分析血管紧张素转换酶抑制剂 (ACEIs) 和血管紧张素受体阻滞剂 (ARB) 的使用，以评估与≥2 级 RP 发生的可能相关性。还评估了患者和剂量测定变量。结果：中位随访期 13.8 个月（范围 3.2-55.0 个月）后，22 名患者出现 2 级 RP。具有外周病变、良好的剂量学数据以及使用 ACEI 和/或 ARB 的患者出现症状性 RP 的风险降低。在未经调整和调整的多变量分析中，ACEI 和/或 ARB 摄入量以及剂量测定变量是具有统计学意义的因素。在二次分析中，具有较大计划目标体积和较高剂量值的患者使用 ACEI 和 ARB 与症状性 RP 风险降低相关。结论：在因肺部病变接受 SBRT 的患者中，使用 RAS 抑制剂与症状性 RP 发生率降低相关。使用 ACEI 和 ARB 可以降低剂量值较高的患者发生≥2 级 RP 的风险。
The use of a renin-angiotensin system (RAS) inhibitor might prevent the occurrence of symptomatic radiation pneumonitis (RP) after radiotherapy for lung tumors. Stereotactic body radiotherapy (SBRT) is often delivered to patients not suitable for surgery; however, it might not be tolerated because most of these patients have advanced age and/or comorbidities. The use of a RAS inhibitor was associated with a reduced occurrence of grade >= 2 RP after SBRT for lung lesions.Introduction: The purpose of the present study was to evaluate the role of renin-angiotensin system (RAS) inhibitors in preventing symptomatic radiation pneumonitis (RP) after stereotactic body radiotherapy (SBRT). Materials and Methods: The data from 158 patients with a solitary lung lesion treated with 1 to 3 fractions of SBRT from December 2008 to July 2014 were retrospectively analyzed. The incidence of RP was evaluated according to the Common Toxicity Criteria for Adverse Events, version 4. The use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) was analyzed to assess for possible correlations with the development of grade >= 2 RP. The patient and dosimetric variables were also assessed. Results: After a median follow-up period of 13.8 months (range, 3.2-55.0 months), 22 patients had developed grade >= 2 RP. Patients with peripheral lesions, favorable dosimetric data, and ACEI and/or ARB use had a reduced risk of symptomatic RP. In unadjusted and adjusted multivariate analyses, ACEI and/or ARB intake and the dosimetric variables were statistically significant factors. In a secondary analysis, the use of ACEIs and ARBs among patients with a greater planning target volume and higher dosimetric values correlated with a reduced risk of symptomatic RP. Conclusion: The use of a RAS inhibitor was associated with a decreased incidence of symptomatic RP among patients undergoing SBRT for lung lesions. Patients with higher dosimetric values had a reduced risk of grade >= 2 RP with ACEI and ARB use.