Chronic lung injury after trimodality therapy for locally advanced non-small cell lung cancer.
Chronic lung injury after trimodality therapy for locally advanced non-small cell lung cancer.
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DOI：
10.1016/j.athoracsur.2020.07.068
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发表时间：
2020-10
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影响因子：
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通讯作者：
J. Soh;S. Sugimoto;K. Namba;A. Miura;T. Shiotani;H. Yamamoto;K. Suzawa;K. Shien;H. Yamamoto;M. Okazaki;K. Katsui;M. Yamane;K. Kiura;S. Kanazawa;S. Toyooka
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作者：
J. Soh;S. Sugimoto;K. Namba;A. Miura;T. Shiotani;H. Yamamoto;K. Suzawa;K. Shien;H. Yamamoto;M. Okazaki;K. Katsui;M. Yamane;K. Kiura;S. Kanazawa;S. Toyooka
背景三联疗法是局部晚期非小细胞肺癌（LA-NSCLC）的一种治疗选择。胸部放射对肺部有早期（放射性肺炎）和晚期（慢性肺损伤[CLI]）的不良影响。虽然CLI预计会导致各种问题，在长期的幸存者，这些表现还没有被精确investigated.MethodsWe招募了112 LA-NSCLC患者接受诱导放化疗，然后手术，然后进行后续计算机断层扫描（CT），每6个月超过1年。所有胸部CT图像进行了审查，以评估任何损伤的肺实质.ResultsCLI在1年后手术和其进展分别观察94（84%）和38（34%）例。进行性肺纤维化作为CLI进展的第一表现，在右中下叶切除术后最常见。空洞形成是进行性肺纤维化的后续表现，慢性感染是CLI的最终阶段。在有空洞形成的患者中，10年时慢性感染的累积率为76.4%。慢性感染10例，其中肺曲霉菌病7例，耐甲氧西林金黄色葡萄球菌或嗜麦芽窄食单胞菌空洞感染2例。其中，4例患者需要手术干预，包括完成肺切除术或开窗术。结论CLI是一个常见的发病率后，LA-NSCLC的三联治疗。CLI经常导致空洞形成，这是需要手术干预的高度难治性慢性感染的前兆。对于三联疗法后CLI的发展，需要建立适当的管理。
BackgroundTrimodality therapy is a treatment option for patients with locally advanced non-small cell lung cancer (LA-NSCLC). Thoracic radiation has both early (radiation pneumonitis) and late (chronic lung injury [CLI]) adverse effects on the lung. While CLI is expected to result in various problems in long-term survivors, these manifestations have not been precisely investigated.MethodsWe enrolled 112 LA-NSCLC patients who had received induction chemoradiotherapy followed by surgery, and then undergone follow-up computed tomography (CT) every 6 months for greater than 1 year. All chest CT images were reviewed to evaluate any injury of the pulmonary parenchyma.ResultsCLI at 1 year after surgery and its progression were observed in 94 (84%) and 38 (34%) patients, respectively. Progressive lung fibrosis as the first manifestation of CLI progression was most frequent after right middle and lower lobectomy. Cavity formation was the subsequent manifestation after progressive lung fibrosis , and chronic infection was the final stage of CLI. The cumulative rate of chronic infection was 76.4% at 10 years in patients with cavity formation. Ten patients with chronic infection included 7 cases of pulmonary aspergillosis and 2 cases of cavity infections with methicillin-resistantStaphylococcus aureusor Stenotrophomonas maltophilia. Among them, 4 patients required surgical interventions including completion pneumonectomy or fenestration.ConclusionsCLI is a common incidence after trimodality therapy for LA-NSCLC. CLI frequently results in cavity formation, which is a precursor of highly refractory chronic infections requiring surgical intervention. Appropriate management needs to be established for CLI developing after trimodality therapy.