乳腺癌术后辅助放疗联合芳香化酶抑制剂或他莫昔芬对放射性肺损伤的影响

Influence of concurrent and sequential combination of postoperative radiation and endocrine therapy （aromatase inhibitor or tamoxifen） on radiation-induced lung injury

目的探讨乳腺癌术后辅助内分泌治疗和放疗（同步或序贯）对放射性肺损伤发生的影响。方法收集于2003年1月至2007年12月间行乳腺癌根治（或改良根治）术后辅助放疗和内分泌治疗的患者，根据入组条件筛选出118例患者，分为4组，放疗（RT）同步芳香化酶抑制剂（AI）组（RT＋AI），放疗同步他莫昔芬（TAM）组（RT＋TAM），放疗序贯AI组（RT—AI），放疗序贯TAM组（RT—TAM）。通过网络影像系统查阅其放疗后1个月和至少12个月间的胸部CT影像资料。结果放射性肺损伤发生率：RT＋AI组（22．7％）和RT—AI组（20．0％）差异无统计学意义（P=0．806），RT＋TAM组（35．7％）和RT-TAM组（24．2％）差异无统计学意义（P=0．328）。高龄患者发生率高于低龄患者（33．9％，16．9％）（P=0．05）。术后有化疗史的患者高于无化疗史的患者（P=0．039）。结论乳腺癌术后辅助化疗以及老年患者存在肺内基础疾病会增加术后放疗放射性肺损伤的发生；放射性肺损伤的发生与是否同步应用TAM或AI内分泌治疗无关。

Objective To compare radiation-induced lung injury （RILI） between concurrent and sequential combination of postoperative radiotherapy and endocrine therapy. Methods A total of 118 patients subjected by radical or modified radical operation of breast cancer were enrolled in this study and received radiotherapy and endocrine therapy between Jan 2003 and December 2007. All the patients were categorized into four groups： radiotherapy（RT） plus concurrent aromatase inhibitor（AI）： RT＋AI; RT plus sequential Ah RT-AI; RT plus tamoxifen （TAM）： RT＋TAM; RT plus sequential TAM： RT-TAM. Radiotherapy was delivered by using various energy of electron （6, 9, 12 Mev β-ray） or 6 My X-ray for different target with a dose of 50 Gy （2 Gy/Fx, 5 fractions per week）. RILI grades were classified according to RTOG/EORTC and Aoki evaluation criteria from one month to at least one year after radiotherapy. Results 30/118（25.4 %） patients was observed with RILI, RT＋AI 22.7 % vs. RT-AI 20.0 %（P =0.806）, RT＋TAM 35.7 % vs. RT-TAM 24.2 % （P =0.328）. The incident rate of RILI was higher in eider patients（〉60 yr） than in other patients （33.9 % vs. 16.9 %, P =0.05）. Patients with positive chemotherapy history had a higher risk of RILl than those with chemotherapy-negtive history （P =0.039）. Conclusion These findings suggest that RILI are associated with age and chemotherapy history, but not correlated with the sequence of radiotherapy and endocrine therapy.