Imaging of gefitinib-related interstitial lung disease: Multi-institutional analysis by the West Japan Thoracic Oncology Group
Imaging of gefitinib-related interstitial lung disease: Multi-institutional analysis by the West Japan Thoracic Oncology Group
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DOI：
10.1016/j.lungcan.2006.02.002
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发表时间：
2006-05-01
期刊：
影响因子：
5.3
通讯作者：
Yamamoto, N
中科院分区：
文献类型：
--
作者：
Endo, M;Johkoh, T;Yamamoto, N
吉非替尼(Iressa(TM))是一种表皮生长因子受体酪氨酸激酶抑制剂，在日本已被批准用于肺癌的治疗，但上市后报告了几例严重的肺部毒性。西日本胸科肿瘤学小组对急性肺毒性和间质进行了一项独立调查。吉非替尼在其成员机构引起的肺部疾病(ILD)。本研究的目的是阐明分子靶向药物吉非替尼引起的ILD的影像特征。2002年8月至12月期间，共有1976名患者接受了吉非替尼的治疗，其中102人被怀疑有急性肺毒性和ILD。至少三位放射科医生在回顾和分析了胸部X线片和CT表现以及病历中的临床资料后，最终确定了吉非替尼所致ILD的诊断。影像表现分为四种类型：(A)磨玻璃样衰减的非特异性区域，(B)多焦点。空域合并面积：(C)毛玻璃衰减呈斑块状分布，并伴有叶间隔。增厚，以及(D)广泛的双侧毛玻璃衰减或合并牵引性支气管扩张症。在102例ILD患者中，65例在发病时进行了CT和胸部摄影，26例仅进行了胸部摄影。排除资料不足的11例和诊断为其他肺部疾病的21例后，70例患者被诊断为吉非替尼所致的ILD。A型29例，B型7例，C型3例，D型20例，其他11例。CT图像A型24例，B型7例，C型1例，D型12例。D型患者的病死率明显高于其他型。D型被认为是弥漫性肺泡损伤的特征。综上所述，分子靶向药物吉非替尼具有一定的肺毒性作用，其所致ILD的影像表现与常规抗肿瘤药物所致的肺毒性相似。(C)2006爱思唯尔爱尔兰有限公司。保留所有权利。
Gefitinib (Iressa(TM)) is an epidermal growth factor receptor tyrosine kinase inhibitor that has been approved for the treatment of lung cancer in Japan, however, after marketing several cases of severe pulmonary toxicity were reported. The West Japan Thoracic Oncology Group conducted an independent survey of acute pulmonary toxicity and interstitial. lung disease (ILD) caused by gefitinib in its member's institutions. The purpose of this study was to clarify the image characteristics of ILD caused by the molecular-targeting drug gefitinib. A total of 1976 patients had been treated with gefitinib between August and December 2002, and 102 of them were suspected of having acute pulmonary toxicity and ILD. A final definite diagnosis of gefitinib-induced ILD was made by at least three radiologists based on a review and analysis of the chest radiography and CT findings plus the clinical data in the medical records. The imaging findings were classified into four patterns: (A) a nonspecific area with ground-glass attenuation, (B) a multifocal. area of airspace consolidations, (C) patchy distribution of ground-glass attenuation accompanied by interlobar septal. thickening, and (D) extensive bilateral ground-glass attenuation or airspace consolidations with traction bronchiectasis. CT as welt as chest radiography had been performed in 65 of the 102 patients at the onset of ILD, and chest radiography alone had been performed in 26. After excluding 11 cases with insufficient data and 21 cases concluded to be other pulmonary diseases, 70 patients were diagnosed with gefitinib-induced ILD. Finally, the diagnostic image findings were classified as pattern A in 29 cases, pattern B in 7 cases, pattern C in 3 cases, pattern D in 20 cases and others in 11 cases. The CT images were classified as pattern A, B, C, and D in 24, 7, 1, and 12 cases, respectively. The mortality rate was significantly higher in the patients with pattern D than the other patterns. Pattern D were thought to represent the features of diffuse alveolar damage. In conclusion, the molecular-targeting drug gefitinib induces pulmonary toxicity at a certain rate and the imaging findings of ILD induced by gefitinib are similar to those of pulmonary toxicity induced by conventional antineoplastic agents. (C) 2006 Elsevier Ireland Ltd. All rights reserved.