减少肺癌患者的辐射肺炎:从中国专家的共识到实践
Yaoyao Zhu1, Yujie Yan1, Jiamei Fu1
1Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Translational lung cancer research
|August 13, 2025
概括
实施关于放射性肺炎 (RP) 的专家共识显著降低了肺癌患者的RP发病率和严重程度. 关键干预措施包括PTV边际限制,个性化肺剂量限制和标准化类固醇使用,改善患者的治疗结果.
科学领域:
- 在瘤学瘤学.
- 辐射疗法 辐射疗法
- 肺部医学 肺部医学
背景情况:
- 放射性肺炎 (RP) 是肺癌患者接受胸部放射治疗的严重并发症.
- 目前用于RP的管理协议的应用不一致,它们在减少RP方面的有效性尚不清楚.
- 这项研究评估了实施中国专家共识指南对RP发生率和严重性的影响.
研究的目的:
- 评估实施专家共识建议在减少辐射肺炎 (RP) 发病率和严重性的有效性.
- 确定与严重RP (级别≥3) 相关的独立临床风险因素.
主要方法:
- 一项对616名肺癌患者进行的回顾性比较研究,这些患者于2020年8月至2022年1月期间接受治疗.
- 根据中国专家对RP管理的共识建议,患者被分为实施前和实施后的组.
- 干预措施包括有限的规划目标体积 (PTV) 边缘,个性化肺剂量限制和标准化类固醇协议. 使用CTCAE v5.0.0评估RP发生率和严重程度.
主要成果:
- 整体RP发生率显著下降,从共识前组的67.3%降至共识后组的55.2% (P=0.003).
- 严重的RP发病率 (等级≥3) 显著减少,从9.9%降至3.4% (P=0.005).
- 严重RP的独立预测因素包括先前存在的间歇性肺病 (ILD),FEV1,DLCO,淋巴细胞计数,有限的PTV边际,标准化类固醇使用,放射治疗剂量和V20.
结论:
- 实施风险因素预防和标准化治疗方案有效降低严重的辐射肺炎 (SRP).
- 临床医生应将共识建议付诸实践,以改善患者的预后和治疗安全性.
- 患有先前存在的ILD,肺功能受损,高剂量放射治疗或低淋巴细胞计数的患者需要特别注意.
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