Impact of Preexisting Interstitial Lung Disease on Acute, Extensive Radiation Pneumonitis: Retrospective Analysis of Patients with Lung Cancer.
Impact of Preexisting Interstitial Lung Disease on Acute, Extensive Radiation Pneumonitis: Retrospective Analysis of Patients with Lung Cancer.
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DOI：
10.1371/journal.pone.0140437
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Suda T
中科院分区：
文献类型：
--
作者：
Ozawa Y;Abe T;Omae M;Matsui T;Kato M;Hasegawa H;Enomoto Y;Ishihara T;Inui N;Yamada K;Yokomura K;Suda T
本研究调查了急性扩展性放射性肺炎的临床特征和预测因素，重点关注既存间质性肺病的存在和放射学特征。在2006年5月至2013年8月期间进行的1429次肺癌照射中，我们回顾了651次涉及肺野的照射。通过治疗前的计算机断层扫描，回顾性评价了既存间质性肺病的存在、与普通型间质性肺炎的相容性以及占位面积。非感染性、非心源性、急性呼吸衰竭并在末次照射后30天内出现扩展性双侧阴影的病例定义为急性扩展性放射性肺炎。9例（1.4%）患者在末次照射后平均6.7天发生急性扩展性放射性肺炎。尽管在13%的患者（84例患者）中发现了既存间质性肺病，但78%的急性扩展性放射性肺炎患者（7例患者）既存间质性肺病，导致无和既存间质性肺病患者的急性扩展性放射性肺炎发生率分别为0.35%和8.3%。多变量logistic分析表明，存在既存间质性肺病（比值比= 22.6; 95%置信区间= 5.29 - 155; p <0.001）和体力状态（≥ 2;比值比= 4.22; 95%置信区间= 1.06 - 20.8; p = 0.049）是显著的预测因素。对84例既存间质性肺病患者的进一步分析显示，累及超过10%的肺野是与急性扩展性放射性肺炎风险相关的唯一独立预测因素（比值比= 6.14; 95%置信区间= 1.0 - 37.4; p = 0.038）。应评估治疗前计算机断层扫描对既存间质性肺疾病的存在和所占面积大小的评估，以便对涉及肺野的区域进行更安全的照射。
This study investigated the clinical characteristics and predictive factors for developing acute extended radiation pneumonitis with a focus on the presence and radiological characteristics of preexisting interstitial lung disease. Of 1429 irradiations for lung cancer from May 2006 to August 2013, we reviewed 651 irradiations involving the lung field. The presence, compatibility with usual interstitial pneumonia, and occupying area of preexisting interstitial lung disease were retrospectively evaluated by pretreatment computed tomography. Cases of non-infectious, non-cardiogenic, acute respiratory failure with an extended bilateral shadow developing within 30 days after the last irradiation were defined as acute extended radiation pneumonitis. Nine (1.4%) patients developed acute extended radiation pneumonitis a mean of 6.7 days after the last irradiation. Although preexisting interstitial lung disease was found in 13% of patients (84 patients), 78% of patients (7 patients) with acute extended radiation pneumonitis cases had preexisting interstitial lung disease, which resulted in incidences of acute extended radiation pneumonitis of 0.35 and 8.3% in patients without and with preexisting interstitial lung disease, respectively. Multivariate logistic analysis indicated that the presence of preexisting interstitial lung disease (odds ratio = 22.6; 95% confidence interval = 5.29–155; p < 0.001) and performance status (≥2; odds ratio = 4.22; 95% confidence interval = 1.06–20.8; p = 0.049) were significant predictive factors. Further analysis of the 84 patients with preexisting interstitial lung disease revealed that involvement of more than 10% of the lung field was the only independent predictive factor associated with the risk of acute extended radiation pneumonitis (odds ratio = 6.14; 95% confidence interval = 1.0–37.4); p = 0.038). Pretreatment computed tomography evaluations of the presence of and area size occupied by preexisting interstitial lung disease should be assessed for safer irradiation of areas involving the lung field.