Radiation-Induced Lung Injury Assessment and Management
Radiation-Induced Lung Injury Assessment and Management
复制标题
辐射引起的肺损伤评估和管理
DOI：
10.1016/j.chest.2019.03.033
复制
发表时间：
2019-07-01
期刊：
影响因子：
9.6
通讯作者：
Ludwig, Michelle
中科院分区：
文献类型：
--
作者：
Hanania, Alexander N.;Mainwaring, Walker;Ludwig, Michelle
放射性肺损伤（RILI）包括放射治疗（RT）引起的任何肺毒性，急性表现为放射性肺炎，慢性表现为放射性肺纤维化。由于大多数胸部和乳房恶性肿瘤患者预计在其一生中接受放疗，其中许多患者具有治疗目的，因此高危人群非常重要。此外，由于立体定向全身放射治疗（SBRT）或立体定向消融放射治疗（SABR）的出现，胸部RT的适应症正在扩大，用于非手术候选人的早期肺癌以及任何实体瘤引起的肺少转移性疾病。幸运的是，随着放疗技术的进步，放射治疗的严重肺部并发症的发生率已经降低。了解放疗与损伤之间的时间关系，以及有助于区分RILI与其他病因的患者、疾病和辐射因素，对于防止误诊是必要的。尽管急性肺炎的治疗取决于临床严重程度，通常对皮质类固醇完全有效，但准确诊断和识别可能进展为纤维化的患者是具有挑战性的。目前的研究进展包括高精度辐射技术、对RILI分子基础的进一步了解、小型和大型动物模型的开发以及用于预防和治疗的候选药物的确定。
Radiation-induced lung injury (RILI) encompasses any lung toxicity induced by radiation therapy (RT) and manifests acutely as radiation pneumonitis and chronically as radiation pulmonary fibrosis. Because most patients with thoracic and breast malignancies are expected to undergo RT in their lifetime, many with curative intent, the population at risk is significant. Furthermore, indications for thoracic RT are expanding given the advent of stereotactic body radiation therapy (SBRT) or stereotactic ablative radiotherapy (SABR) for early-stage lung cancer in nonsurgical candidates as well as oligometastatic pulmonary disease from any solid tumor. Fortunately, the incidence of serious pulmonary complications from RT has decreased secondary to advances in radiation delivery techniques. Understanding the temporal relationship between RT and injury as well as the patient, disease, and radiation factors that help distinguish RILI from other etiologies is necessary to prevent misdiagnosis. Although treatment of acute pneumonitis is dependent on clinical severity and typically responds completely to corticosteroids, accurately diagnosing and identifying patients who may progress to fibrosis is challenging. Current research advances include high-precision radiation techniques, an improved understanding of the molecular basis of RILI, the development of small and large animal models, and the identification of candidate drugs for prevention and treatment.