TKI同期放疗诱发间质性肺病的临床研究

A clinical study of interstitial lung disease induced by TKI concurrent radiotherapy

目的探讨口服EGFR-TKI同期放疗晚期NSCLC是否增加间质性肺病（ILD）发生并分析影响发生的因素。方法回顾研究2010--2014年本院收治的72例采用口服EGFR—TKI同期放疗的NSCLC患者资料，同时收集相关病例作为对照。研究共分姑息化疗组、单药TKI组、同期放化疗组及TKI同期放疗组，比较TKI同期放疗组与其他治疗组ILD发生率；采用单因素x2检验联合多因素Logistic回归模型分析影响TKI同期放疗组患者ILD发生的风险因素。结果姑息化疗组、单药TKI组、同期放化疗组及TKI同期放疗组ILD发生率分别为2．5％、12％、7．5％、19．4％（P=0．045）。多因素回归分析显示影响TKI同期放疗组ILD发生的风险因素为男性、长期吸烟、合并基础肺疾病、肿瘤病灶〉5cm以及采用常规放疗手段等。结论TKI同期放疗晚期NSCLC可能会导致ILD发生率增加。

Objective To investigate the influence of radiotherapy with concurrent oral epidermal growth factor receptor （EGFR） and tyrosine kinase inhibitor （TKI） for advanced non-small cell lung cancer （NSCLC） on the incidence of interstitial lung disease （ILD）, and to analyze the risk factors for the pathogenesis of ILD. Methods The incidence of ILD in 72 patients with NSCLC who were admitted to Department of Radiotherapy Oncology of Lu＇an Hospital of Traditional Chinese Medicine and treated with radiotherapy with concurrent oral EGFR-TKI from January 2010 to January 2014 was analyzed retrospectively, and some patients were selected as controls to compare the difference in the incidence of ILD between the TKI concurrent radiotherapy group and the other groups. The univariate analysis using ehi-square test and multivariate logistic regression analysis were applied to analyze the risk factors for the incidence of ILD in the patients receiving TKI concurrent radiotherapy. Results The TKI concurrent radiotherapy group had a significantly higher incidence rate of ILD than the palliative chemotherapy group, single TKI group, and concurrent chemoradiotherapy group （ 19. 4% vs. 2. 5%, 12%, and 7. 5%, P= 0. 045 ）. The multivariate regression analysis showed that male sex, long-term smoking, underlying lung disease, tumor volume〉5 cm, and application of conventional radiotherapy were the risk factors for the pathogenesis of ILD in the TKI concurrent radiotherapy group. Conclusions Radiotherapy with concurrent TKI for advanced NSCLC may increase the incidence of ILD.