FeNO预测肺癌患者放射性肺炎的临床价值

Clinical value of FeNO in predicting radiation pneumonia in lung cancer patients

目的:观察肺癌患者放疗后一氧化氮分数(FeNO)的增加能否提示放射性肺损伤。方法:本研究中,我们评估了FeNO变化与放疗后呼吸症状、CT扫描改变和剂量体积直方图(DVH)参数之间的关系。测量65例肺癌患者放疗前及放疗后4、5、6、10周和4、7.5月的FeNO。结果:在放疗后,11名肺癌患者(17%)自述有明显的呼吸道症状,21名(32%)患者有超过1/3的被照射肺区表现出放射性肺炎样图像。13名患者(20%)的FeNO增加超过10 ppb。以FeNO增加超过10 ppb为标准诊断放疗相关呼吸症状的灵敏度和特异性分别为18%和83%。FeNO变化与放疗后DVH参数或CT扫描改变之间无显著相关性。3名患者(5%)在第4、5周持续表现出异常高水平的FeNO(2或3倍,高达55 ppb),随后出现了显著的呼吸症状和/或放射性肺炎图像。结论:放疗期间的连续FeNO监测预测肺癌患者放射性肺炎症状或图像的能力较差。然而,三名患者表现出的特定模式值得研究。

Objective:To observe whether the increase of nitric oxide fraction(FeNO)in lung cancer patients after radiotherapy can prompt the radiation lung injury.Methods:In this study,we assessed the relationships between FeNO variations and respiratory symptoms,CT scan changes or dose volume histogram(DVH)parameters after RT.We measured FeNO before RT,4,5,6,10 weeks,4 and 7.5 months after RT in 65 lung cancer patients.Results:Eleven lung cancer patients(17%)complained of significant respiratory symptoms and 21(32%)had radiation pneumonitis images in>1/3 of the irradiated lung after RT.Thirteen patients(20%)showed increases in FeNO>10 ppb.The sensitivity and specificity of a>10 ppb FeNO increase for the diagnosis of RT-associated respiratory symptoms were 18%and 83%,respectively.There was no correlation between DVH parameters or CT scan changes after RT and FeNO variations.Three patients(5%)showed intriguingly strong(2 or 3-fold,up to 55 ppb)and sustained increases in FeNO at 4 and 5 weeks,followed by significant respiratory symptoms and/or radiation-pneumonitis images.Conclusion:Serial FeNO measurements during RT have a low ability to identify lung cancer patients who develop symptoms or images of radiation pneumonitis.However,three patients presented with a particular pattern which deserves to be investigated.