Inhalative steroids as an individual treatment in symptomatic lung cancer patients with radiation pneumonitis grade II after radiotherapy - a single-centre experience.
Inhalative steroids as an individual treatment in symptomatic lung cancer patients with radiation pneumonitis grade II after radiotherapy - a single-centre experience.
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DOI：
10.1186/s13014-016-0580-3
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发表时间：
2016-02-02
期刊：
影响因子：
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通讯作者：
Dickgreber N
中科院分区：
文献类型：
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作者：
Henkenberens C;Janssen S;Lavae-Mokhtari M;Leni K;Meyer A;Christiansen H;Bremer M;Dickgreber N
评估吸入性类固醇（IS）治疗肺癌伴症状性放射性肺炎（RP）II级患者的单中心经验的疗效。2009年5月至2010年7月，24例患者（女性，n = 8;男性，n = 16）肺癌（非小细胞肺癌[NSCLC]：n = 19;小细胞肺癌[SCLC]：n = 3;组织学未知：n = 2）和良好体能状态（ECOG ≤1）对原发肿瘤部位和受累淋巴结接受明确放疗，同时接受化疗（n = 18），序贯化疗（n = 2）或仅放疗（n = 4），并在随访期间出现症状性RP II级。没有患者出现需要氧气的RP III级。诊断时的平均年龄为66岁（范围：50-82岁）。9名患者在治疗前患有慢性阻塞性肺疾病（COPD），18名患者有吸烟史（中位吸烟年数：48）。平均肺剂量为15.5戈伊（范围：3.0-23.1戈伊）。所有患者均接受IS治疗。如果患者的临床症状在IS治疗开始后两周内没有显著改善，则将其治疗转为口服泼尼松龙。所有24例患者最初均接受高剂量IS（布地奈德800 μg 1-0-1）治疗14天。在这些患者中，18例患者的临床症状有显著改善，6例患者的临床症状无显著改善，被归类为IS无应答者。两周后，他们的治疗转为口服类固醇（从口服泼尼松龙开始，0.5 mg/kg体重;每天至少50 mg）。所有这些患者均对泼尼松龙有反应。无应答者均未出现RP症状增加和需要吸氧和/或住院治疗（RP III级）。IS治疗开始后的中位随访时间为18个月（范围：4-66个月）。IS治疗和泼尼松龙治疗的中位持续时间分别为8.2个月（范围：3.0-48.3个月）和11.4个月（范围：5.0-44.0个月）。在18例IS治疗应答者中，2例（11.1%）既存2级COPD患者分别在放疗后45.0和48.3个月仍需要IS（400 μg，每日两次）。对于其余16例应答者（88.9%），IS治疗在7.7个月后停止（范围：3.0-18.2个月）。IS治疗的患者均未出现任何特定的IS相关副作用，如口腔念珠菌病。该单中心经验表明，高剂量IS是体能状态良好患者放射性肺炎II级的个体化治疗选择。
To assess efficacy of our single-centre experience with inhalative steroids (IS) in lung cancer patients with symptomatic radiation pneumonitis (RP) grade II. Between 05/09 and 07/10, 24 patients (female, n = 8; male, n = 16) with lung cancer (non-small cell lung carcinoma [NSCLC]: n = 19; small cell lung cancer [SCLC]: n = 3; unknown histology: n = 2) and good performance status (ECOG ≤1) received definitive radiotherapy to the primary tumour site and involved lymph nodes with concurrent chemotherapy (n = 18), sequential chemotherapy (n = 2) or radiation only (n = 4) and developed symptomatic RP grade II during follow-up. No patient presented with oxygen requiring RP grade III. The mean age at diagnosis was 66 years (range: 50–82 years). Nine patients suffered from chronic obstructive pulmonary disease (COPD) before treatment, and 18 patients had a smoking history (median pack years: 48). The mean lung dose was 15.5 Gy (range: 3.0–23.1 Gy). All patients were treated with IS. If a patient’s clinical symptoms did not significantly improve within two weeks of IS therapy initiation, their treatment was switched to oral prednisolone. All 24 patients were initially treated with a high dose IS (budesonide 800 μg 1-0-1) for 14 days. Of the patients, 18 showed a significant improvement of clinical symptoms and 6 patients did not show significant improvement of clinical symptoms and were classified as non-responders to IS. Their treatment was switched to oral steroids after two weeks (starting with oral prednisolone, 0.5 mg/kg bodyweight; at least 50 mg per day). All of these patients responded to the prednisolone. None of non-responders presented with increased symptoms of RP and required oxygen and / or hospitalization (RP grade III). The median follow-up after IS treatment initiation was 18 months (range: 4–66 months). The median duration of IS treatment and prednisolone treatment was 8.2 months (range: 3.0–48.3 months) and 11.4 months (range: 5.0–44.0 months), respectively. Of the 18 IS treatment responders, 2 (11.1 %) patients with pre-existing grade 2 COPD still required IS (400 μg twice a day) 45.0 and 48.3 months after radiotherapy, respectively. For the remaining 16 responders (88.9 %), IS therapy was stopped after 7.7 months (range: 3.0–18.2 months). None of the patients treated with IS developed any specific IS-related side effects such as oral candidiasis. This single-centre experience shows that high-dose IS is an individual treatment option for radiation-induced pneumonitis grade II in patients with a good performance status.