A descriptive study of pulmonary complications after postoperative radiation therapy in node-positive stage II breast cancer.
A descriptive study of pulmonary complications after postoperative radiation therapy in node-positive stage II breast cancer.
复制标题
淋巴结阳性 II 期乳腺癌术后放射治疗后肺部并发症的描述性研究。
作者：
Pehr A. Lind;G. Gagliardi;B. Wennberg;T. Fornander
本研究旨在评估II期结节阳性乳腺癌患者术后采用不同治疗方法辅助放疗后出现症状性肺部并发症的频率。1991年至1993年，共有177例患者转诊至斯德哥尔摩S医院放疗科，其中144例行改良根治术，33例行乳房部分切除术。对这些患者治疗后1-7个月的临床诊断为放射治疗所致肺部并发症的记录进行回顾性研究。138例乳腺癌改良根治术后接受放射治疗的患者中，33例(24%)出现肺部并发症，其中20例(14%)被诊断为严重，即需要使用皮质类固醇药物治疗。用于治疗胸壁的不同电子能量和呼吸道副作用的发生率之间没有统计学意义上的差异。33名患者中有18名患者在部分乳房切除术后完成了规定的治疗。18例患者中有9例(50%)出现肺部并发症，4例(22%)出现严重反应。15名患者接受了替代治疗。在部分乳房切除术后，出现呼吸道副作用的患者的中位中央肺距离为32 mm，而未受影响的患者的中位中央肺距离为25 mm(p=0.03)。这项研究确定急性/亚急性肺部副作用是一个临床上重要的问题。有必要对肺功能测试、危险因素识别和个体肺剂量体积直方图进行前瞻性随访，以评估长期影响。
This study was conducted to assess the frequencies of symptomatic pulmonary complications following adjuvant postoperative radiotherapy using different treatment techniques in patients with Stage II node-positive breast cancer. During 1991-1993, 177 patients were referred to the Radiotherapy Department of Stockholm Söder Hospital; 144 after modified radical mastectomy and 33 after partial mastectomy. The records of these patients were studied retrospectively for clinically diagnosed radiotherapy-induced lung complications 1-7 months after treatment. Thirty-three of 138 patients (24%) irradiated after modified radical mastectomy developed pulmonary complications and 20 (14%) of these were diagnosed as severe, i.e. needing medical treatment with corticosteroids. No statistically significant difference could be found between the different electron energies used for treating the chest wall and the frequency of respiratory side-effects. Eighteen of 33 patients completed the prescribed treatment after partial mastectomy. Nine of these 18 patients (50%) developed pulmonary complications and 4 (22%) developed severe reactions. Fifteen patients received alternative treatments. With the techniques used after partial mastectomy the median central lung distance was 32 mm among the patients who experienced respiratory side-effects compared with 25 mm among the patients who were not affected (p = 0.03). This study identifies acute/subacute pulmonary side-effects as a clinically significant problem. Prospective follow-up with lung function tests, identification of risk factors, and individual lung dose volume histograms is warranted to assess the long-term implications.