The Role of Lung Lobes in Radiation Pneumonitis and Radiation-Induced Inflammation in the Lung: A Retrospective Study.
The Role of Lung Lobes in Radiation Pneumonitis and Radiation-Induced Inflammation in the Lung: A Retrospective Study.
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DOI：
10.1007/s13566-012-0079-y
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发表时间：
2013-06-01
期刊：
影响因子：
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通讯作者：
Guerrero T
中科院分区：
文献类型：
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作者：
McCurdy M;Bergsma DP;Hyun E;Kim T;Choi E;Castillo R;Castillo E;Guerrero T
我们使用标准化的[18F]-氟脱氧葡萄糖（FDG）摄量，检测了在接受光子或质子治疗的患者中，上肺叶（UL）与正常肺组织下肺叶（LL）对辐射的相对反应，并测试了辐射反应与临床肺炎的相关性。选择2003年11月1日至2011年5月15日食管癌患者75例（光子51例或质子24例），在放化疗后1 ~ 3个月接受fdg -正电子发射断层扫描（PET）成像。以主裂为界，对左、左二叶进行轮廓，右中叶包含在右左二叶结构中。肺炎毒性评分采用不良事件通用术语标准4.0版，基于5名临床医生的共识。与UL相比，LL具有较高的平均剂量（15.6 Gy vs. 10.4 Gy, p<0.001），较高的平均标准摄取值（SUV） （0.78 vs. 0.56, p=0.001）和低剂量区域的SUV (0.80 vs. 0.66, p=0.001)，以及较低的平均剂量反应（0.015 vs. 0.019, p=0.003）。UL与LL的平均剂量比（p < 0.001），以及0 ~ 10 Gy肺部区域的SUV （p=0.04）与症状性肺炎相关，但UL与LL的剂量反应比（p=0.53）与症状性肺炎无关。上肺叶的肺代谢辐射反应大于下肺叶。治疗后PET低剂量区（10-20 Gy）， UL相对于LL的剂量越大，SUV越高，与症状性肺炎相关。
We examined the relative response to radiation of the upper lung lobes (UL) versus lower lung lobes (LL) of normal lung tissue using normalized [18F]-fluorodeoxyglucose (FDG) uptake per radiation dose received per lung voxel in patients treated with either photons or protons and tested for correlation of the radiation response with clinical pneumonitis. Seventy-five patients (photon (n = 51) or proton (n = 24)) treated for esophageal cancer from November 1, 2003 to May 15, 2011 who received restaging FDG-positron emission tomography (PET) imaging 1 to 3 months after chemoradiation were selected. UL and LL were contoured using the major fissure as the boundary, with the right middle lobe being included in the right UL structure. Pneumonitis toxicity was scored using the Common Terminology Criteria for Adverse Events, version 4.0 based on the consensus of 5 clinicians. LL had a higher mean dose (15.6 Gy vs. 10.4 Gy, p<0.001), higher mean standard uptake value (SUV) (0.78 vs. 0.56, p=0.001) and SUV in low dose regions (0.80 vs. 0.66 for 10 to 20 Gy, p=0.001), and lower mean dose response (0.015 vs. 0.019, p=0.003) compared to the UL. The mean dose ratio of UL vs. LL (p < 0.001), and SUV in the region of lung receiving 0-10 Gy (p=0.04), but not the dose response ratio of UL vs. LL (p=0.53) correlated with symptomatic pneumonitis. Upper lung lobes had a greater pulmonary metabolic radiation response than lower lung lobes. Greater dose to UL relative to LL and higher SUV in the low dose region (10-20 Gy) on post-treatment PET correlated with symptomatic pneumonitis.