Analysis of clinical characteristics of symptomatic radiation-induced lung injury in patients with non-small cell lung cancer after radiotherapy
XU Hui-min, CAO Jian-zhong, WANG Jing-bo, HUI Zhou-guang, Lü Ji-ma, LIANG Jun, ZHOU Zong-mei, FENG Qin-fu, CHEN Dong-fu, ZHANG Hong-xing, XIAO Ze-fen, YIN Wei-bo, WANG Lü-hua
Departments of Radiation Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, ChinaCorresponding author:WANG Lü-hua, Email:wlhwq@yahoo.com
Abstract：Objective To analyze the clinical characteristics of symptomatic radiation-induced lung injury (SRILI) in patients with non-small cell lung cancer (NSCLC) after radiotherapy. Methods A retrospective analysis was performed on the patients with NSCLC who received radiotherapy in our hospital from January 2000 to May 2007 and who developed SRILI during therapy or follow-up and received related treatment in our hospital. The symptoms, clinical signs, imaging findings, and hematological changes of the patients were observed. The SRILI was diagnosed and classified by 2 radiation oncologists and 1 radiologist according to CTC 3.0 criteria. Results A total of 81 SRILI patients were included in the analysis. Of them, 35 had grade 2 SRILI, 42 had grade 3 SRILI, 0 had grade 4 SRILI, and 4 had grade 5 SRILI. The median time from beginning of radiotherapy to onset of SRILI symptoms was 8.3 weeks (ranging from 1.3 to 32.3 weeks). Among the SRILI symptoms, cough was observed in 95% of the patients, short breath in 69% of the patients, and fever in 48% of the patients. The median highest body temperature was 38.3℃. The clinical signs, found in relatively few patients, included coarse breath sound as the common one, seen in about 50% of the patients. The imaging findings included lung consolidation, air bronchogram, patchy opacities, and linear opacities, most of which were found in the radiation field. The hematological changes included slightly elevated percentage of neutrophils (median=77.4%). Conclusions The symptoms of SRILI occurred at 8.3(median) weeks after the beginning of radiation. The clinical characteristics of SRILI include cough, short breath, fever, coarse breath sound, imaging findings of lung consolidation, patchy opacities, and linear opacities, which are mostly found in the radiation field, and slightly elevated percentage of neutrophils.
XU Hui-min,CAO Jian-zhong,WANG Jing-bo et al. Analysis of clinical characteristics of symptomatic radiation-induced lung injury in patients with non-small cell lung cancer after radiotherapy[J]. Chinese Journal of Radiation Oncology, 2013, 22(2): 118-122.
[1] Sunyach MP, Falchero L, Pommier P, et al. Prospective evaluation of early lung toxicity following three-dimensional conformal radiation therapy in non-small-cell lung cancer:Preliminary results. Int J Radiat Oncol Biol Phys,2000,48:459-463. [2] Rosenman JG, Halle JS, Socinski MA, et al. High-dose conformal radiotherapy for treatment of stage ⅢA/ⅢB non-small cell lung cancer:technical issues and results of a phase Ⅰ/Ⅱ trial. Int J Radiat Oncol Biol Phys,2002,54:348-356. [3] 王静波,曹建忠,姬巍,等.局部晚期非小细胞肺癌三维放疗后放射性肺损伤风险因素分析.中华放射肿瘤学杂志,2012,21:114-120. [4] Hines L. Fibrosis of the lung following roentgen-ray treatments for tumor. JAMA,1922,79:720-722. [5] Palma DA, Senan S, Tsujino K, et al. Predicting radiation pneumonitis after chemoradiation therapy for lung cancer:an international individual patient data Meta-analysis. Int J Radiat Oncol Biol Phys,2012,In press. [6] Inoue A, Kunitoh H, Sekine I, et al. Radiation pneumonitis in lung cancer patients:a retrospective study of risk factors and the long-term prognosis. Int J Radiat Oncol Biol Phys,2001,49:649-655. [7] Zhao L, Sheldon K, Chen M, et al. The predictive role of plasma TGF-beta1 during radiation therapy for radiation-induced lung toxicity deserves further study in patients with non-small cell lung cancer. Lung Cancer,2008,59:232-239. [8] Kocak Z, Evans ES, Zhou SM, et al. Challenges in defining radiation pneumonitis in patients with lung cancer. Int J Radiat Oncol Biol Phys,2005,62:635-638. [9] Yirmibesoglu E, Higginson DS, Fayda M, et al. Challenges scoring radiation pneumonitis in patients irradiated for lung cancer. Lung Cancer,2012,76:350-353. [10] Marks LB, Yu X, Vujaskovic Z, et al. Radiation-induced lung injury. Semin Radiat Oncol,2003,13:333-345. [11] McDonald S, Rubin P, Phillips TL, et al. Injury to the lung from cancer therapy:clinical syndromes, measurable endpoints, and potential scoring systems. Int J Radiat Oncol Biol Phys,1995,31:1187-1203. [12] Monson JM, Stark P, Reilly JJ, et al. Clinical radiation pneumonitis and radiographic changes after thoracic radiation therapy for lung carcinoma. Cancer,1998,82:842-850. [13] 程文芳,钱飞宇,李云英.肺癌放疗与放射性肺炎的研究.实用肿瘤学杂志,2000,14:274-275. [14] 张晓晶,孙建国,孙洁,等.肺癌三维适形放射治疗所致放射性肺炎的相关因素分析.重庆医学,2012,41:1065-1068. [15] Wang J, Cao J, Yuan S, et al. Poor baseline pulmonary function may not increase the risk of radiation-induced lung toxicity. Int J Radiat Oncol Biol Phys,2012,In press. [16] Graves PR, Siddiqui F, Anscher MS, et al. Radiation pulmonary toxicity:from mechanisms to management. Semin Radiat Oncol,2010,20:201-207. [17] Nelson DH, Sandberg AA, Palmer JG, et al. Blood levels of 17-hydroxycorticosteroids following the administration of adrenal steroids and their relation to levels of circulating leukocytes. J Clin Invest,1952,31:843-849. [18] Mah K, Poon PY, Van Dyk J, et al. Assessment of acute radiation-induced pulmonary changes using computed tomography. J Comput Assist Tomogr,1986,10:736-743. [19] Morgan GW, Breit SN. Radiation and the lung:a reevaluation of the mechanisms mediating pulmonary injury. Int J Radiat Oncol Biol Phys,1995,31:361-369.
2013, Vol. 22 
