Retrospective analysis of steroid therapy for radiation-induced lung injury in lung cancer patients
Retrospective analysis of steroid therapy for radiation-induced lung injury in lung cancer patients
复制标题
DOI：
10.1016/j.radonc.2006.06.007
复制
发表时间：
2006-07-01
影响因子：
5.7
通讯作者：
Tamura, Tomohide
中科院分区：
文献类型：
--
作者：
Sekine, Ikuo;Sumi, Minako;Tamura, Tomohide
目的：为探讨肺癌患者放射性肺损伤的特点，对385例肺癌患者行50-70戈伊后放射性肺损伤的影像学改变、症状、激素使用史及临床病程进行回顾性分析。307例患者（第1组）的放射性肺损伤在未使用皮质类固醇的情况下稳定，64例患者（第2组）的放射性肺损伤在使用皮质类固醇的情况下稳定，14例患者（第3组）的放射性肺损伤在使用皮质类固醇的情况下进展至死亡。第1-3组中分别有11%、50%和86%（p < 0.001）以及1 - 3%、44%和57%（p < 0.001）的患者出现发热和呼吸困难。第1-3组放疗结束与首次放射学变化之间的中位周数分别为9.9、6.7和2.4周（p < 0.001）。52例（67%）患者的泼尼松龙初始等效剂量为30-40 mg/d。16例（4.2%）患者死于放射性肺炎或激素并发症，中位生存期为45（8-107）d.Conclusion：发热、呼吸困难、放疗结束与首次影像学改变间隔时间短与放射性肺损伤有关。泼尼松龙30-40 mg/d是治疗的首选药物。(c)2006爱思唯尔爱尔兰有限公司保留所有权利。
Purpose: To disclose characteristics of lung cancer patients developing radiation-induced lung injury treated with or without corticosteroid therapy.Methods and materials: Radiographic changes, symptoms, history of corticosteroid prescription, and clinical course after 50-70 Gy of thoracic radiotherapy were retrospectively evaluated in 385 lung cancer patients.Results: Radiation-induced lung injury was stable without corticosteroid in 307 patients (Group 1), stable with corticosteroid in 64 patients (Group 2), and progressive to death despite corticosteroid in 14 patients (Group 3). Fever and dyspnea were noted in 11%, 50% and 86% (p < 0.001), and in 13%, 44 % and 57 % (p < 0.001) patients in Groups 1-3, respectively. Median weeks between the end of radiotherapy and the first radiographic change were 9.9, 6.7 and 2.4 for Groups 1-3, respectively (p < 0.001). The initial prednisolone equivalent dose was 30-40 mg daily in 52 (67%) patients. A total of 16 (4.2%) patients died of radiation pneumonitis or steroid complication with a median survival of 45 (range, 8-107) days.Conclusion: Development of fever and dyspnea, and short interval between the end of radiotherapy and the first radiographic change were associated with fatal radiation-induced lung injury. Prednisolone 30-40 mg daily was selected for the treatment in many patients. (c) 2006 Elsevier Ireland Ltd. All rights reserved.