J Thora Oncol:間質性肺病是引發肺部炎症的顯著性風險因子

2014年11月12日 訊 /生物谷BIOON/ --近日，一項來自國際肺癌研究協會研究人員的研究指出，間質性肺病或許是引發肺部炎症的明顯風險因子，相關研究發表於國際雜誌the Journal of Thoracic Oncology上。預處理間質性肺病（ILD）是引發I期非小細胞肺癌病人患嚴重輻射性肺炎的風險因子，而這些非小細胞肺癌患者往往僅用體部立體定向放射進行治療（SBRT）。

ILD會引發患者肺部組織及氣囊空間發生結瘢及僵硬，最終會導致氣體交換的減少；肺癌患者中ILD的發生率高於一般人群，某些ILD的肺癌患者並不會被作為外科療法的最佳候選者；立體定向放射治療（SBRT）利用複雜的技術將靶向性的集中輻射劑量運輸至腫瘤部位來阻斷損傷癌症組織的生長，而SBRT也被認為是用於早期非小細胞肺癌患者的可接受的療法，這些患者往往不會作為外科手術的最佳候選人。

為了確定治療ILD早期肺癌患者的最佳療法，研究人員檢測了157名I期非小細胞肺癌病人的放射性肺炎情況及臨床治療結果（這些病人處於SBRT療法中），研究結果顯示，在157名以SBRT療法為肺癌療法的患者中，有20名患者被鑑別出為預處理的間質性肺病患者，ILD的存在是有症狀放射性肺炎及嚴重放射性肺炎的顯著性風險因子，而且放射性肺炎的累積發生率隨著ILD病情的嚴重會明顯增加。

ILD陽性的患者總的生存期趨於縮短，但在統計學上並不明顯，這或許是因為ILD本身所決定的；最後研究人員表示，我們的研究結果顯示，ILD對放射性肺炎的影響依賴於患者先前疾病的嚴重程度，如果ILD的嚴重性和放射性肺炎的風險被仔細評估，那麼SBRT或許就是針對早期階段非小細胞肺癌患者及預處理間質性肺病患者的疾病最佳根治療法。（生物谷Bioon.com）

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Impact of Pretreatment Interstitial Lung Disease on Radiation Pneumonitis and Survival after Stereotactic Body Radiation Therapy for Lung Cancer.

Ueki, Nami MD; Matsuo, Yukinori MD, PhD; Togashi, Yosuke MD; Kubo, Takeshi MD; Shibuya, Keiko MD, PhD; Iizuka, Yusuke MD; Mizowaki, Takashi MD, PhD; Togashi, Kaori MD, PhD; Mishima, Michiaki MD, PhD; Hiraoka, Masahiro MD, PhD

Introduction: To investigate the impact of pre-existing radiological interstitial lung disease (ILD) findings on the incidence of radiation pneumonitis (RP) and clinical outcomes after stereotactic body radiation therapy (SBRT) for stage I non-small-cell lung cancer. Methods: We included 157 consecutive patients who underwent SBRT alone for stage I non-small-cell lung cancer and whose pretreatment lung computed tomography images were available for retrospective review. The pretreatment computed tomography images were evaluated retrospectively for the presence of ILD. The incidence of RP, overall survival (OS) rate, and the incidence of disease progression and local progression were evaluated between patients with ILD (ILD[+]) and without ILD (ILD[-]). Results: Pre-existing ILD was identified in 20 patients. The median follow-up period was 39.5 months. The incidences of RP worse than grade 2 (>= Gr2 RP) and worse than grade 3 (>= Gr3 RP) were significantly higher in ILD(+) than ILD(-) (1 year >= Gr2 RP rate, 55.0% versus 13.3%; p < 0.001 and 1year >= Gr3 RP rate 10.0% versus 1.5%; p = 0.020). Multivariate analysis also indicated that ILD(+) was a risk factor for >= Gr2 and >= Gr3 RP, and the volume of the irradiated lung. The OS rate tended to be worse in ILD(+) than ILD(-) (3-year OS, 53.8% versus 70.8%; p = 0.28). No difference was observed in the disease progression or local progression rates. Conclusions: Pre-existing ILD was a significant risk factor for symptomatic and severe RP. Prescreening for ILD findings is important for determining the radiation pneumonitis risk when planning SBRT.