非小细胞肺癌放疗后有症状放射性肺损伤临床特点分析

Analysis of clinical characteristics of symptomatic radiation-induced lung injury in patients with non-small cell lung cancer after radiotherapy

目的分析非小细胞肺癌（NSCLC）患者放疗后发生有症状放射性肺损伤（SRILI）的临床特点。方法回顾分析2000--2007年放疗的NSCLC患者治疗期间或随访中发生并在本院治疗的SRILI临床症状、体征、影像及血液学改变等。SRILI经2名放疗科和1名影像科医生根据不良反应常见术语标准3．0版进行诊断和分级。结果81例SRILI患者纳入分析，其中2级35例、3级42例、4级0例、5级4例。自放疗开始SRILI症状出现时间中位数8．3周。SRILI症状主要为咳嗽（95％）、气短（69％）、发热（48％），最高体温中位数38．3℃。临床体征相对较少，常见为呼吸音粗糙（50％）。影像表现为放射野内肺实变、通气支气管征、斑片和条索影，少数出现在放射野外。血象改变为中性粒细胞比例稍高（中位数77．4％）。结论SRILI出现在放疗开始后平均8．3周，临床特点表现为咳嗽、气短、发热、呼吸音粗糙，放射野内或少数野外实变、斑片、条索影，中性粒细胞比例稍高。

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~C. 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 ueutrophils.