Diagnosis and treatment of radiation pneumonia / 中华放射肿瘤学杂志

Radiation pneumonia is a part of radiation-induced lung injury, and its injury and repair is a complex pathophysiological process involving with the participation and interaction among numerous cells and cytokines. Early diagnosis and treatment of radiation pneumonia can alleviate lung injury and protect lung fuction. Compared with infectious pneumonia, there is no obvious difference in symptoms and physical signs. However, the symptoms are relatively mild, the total count of white blood cells is not significantly elevated or only the classification of neutrophils is relatively high. Hormone can stimulate the increase of white blood cells, which should be delivered prior to relevant examination. CT scan is a sensitive tool to make the diagnosis of radiation pneumonia, which can be utilized for staging, guiding treatment and prognosis evaluation. The lung injury changes of radiation pneumonia on CT scan can be observed 7-10 d later than relevant symptoms. Besides symptomatic treatment, such as cough relief and phlegm elimination, hormone is the key treatment of radiation pneumonia. It is recommended to deliver long-acting dexamethasone or prednisone with an initial small dose, adjusted to effective dose according to disease condition, maintained for 3-4 weeks, and gradually reduced to avoid the recurrence of radiation pneumonia. Pulse therapy for hormone is likely to lead to insufficient or excessive dose and affect the therapeutic effect. Insufficient dose can cause the occurrence of recurrent radiation pneumonia.

Research progress in radiation-induced lung injury / 中华放射肿瘤学杂志

Radiation-induced lung injury ( RILI) is a severe complication which commonly occurs after radiotherapy in patients diagnosed with thoracic cancer patients. RILI includes acute radiation-induced pneumonitis and fibrosis. RILI not only limits the radiotherapy dose, but also affects subsequent clinical efficacy and quality of life of patients. The mechanism underlying RILI has been mainly investigated in animal models. Multiple cells, cytokines and molecules participate in the regulation of immune response, eventually leading to the incidence of RILI. No guidelines or standards have been established for the treatment of RILI, which primarily depend upon clinical experience and professional recommendations. In this article, recent RILI-related studies have been summarized to unravel the pathophysiological changes, clinical symptoms, imaging findings, clinical diagnosis and treatment of RILI.

How to reduce radiotherapy-induced lung injury in the treatment of non-small cell lung cancer / 中华放射肿瘤学杂志

Radiotherapy is one of the main therapeutic methods of lung cancer, whereas the lung injury induced by radiotherapy restricts the quality of life and clinical efficacy. It is a challenge to improve the clinical efficacy and reduce lung injury.Based upon clinical experience, certain measures can be taken to alleviate the lung injury after thoracic radiotherapy. The severity and complications of lung cancer and the concurrent chemoradiotherapy-induced injury should be comprehensively understood to establish individual therapeutic strategy. The diagnostic skills, biological characteristics of tumors, the diffusion, metastasis and recurrence of tumors and lymphatic drainage should be mastered and considered in the formulation of treatment target areas to minimize unnecessary radiation for every 1 mm. During the formulation and evaluation of radiotherapy plans, we should understand the biological characteristics of the lung and lung injury repair and stick to the principle of high-dose radiation for small-volume lung rather than low-dose radiation for large-volume lung. A better treatment plan should be established to reduce every 1% of lung DVH as possible even at the expanse of conformality. Simultaneous modulated accelerated radiotherapy and two-phase radiotherapy are employed to distinguish normal tissues from subclinical tumors from the dose and fractioned dose aspects, which further enhance the tumor control and alleviate lung injury. The lung ventilation function is lost at a dose of 20 Gy or higher. Extensive attention should be delivered to reduce the radiation dose to the lung, especially for the repair of non-functional lung fibrosis. Precise and individualized radiotherapy should be adopted to reduce unnecessary radiation and protect the normal lung tissues, which improve the clinical efficacy and enhance the quality of life.

Clinical effect of intraoperative electron beam radiotherapy in treatment of unresectable locally advanced pancreatic cancer / 中华放射肿瘤学杂志

Objective To assess the prognostic benefits of intraoperative radiotherapy (IORT) with electron beam among patients with unresectable locally advanced pancreatic cancer.Methods Between January 2009 and December 2014,167 patients with unresectable locally advanced pancreatic cancer received IORT with electron beam (10-20 Gy) in our hospital.After surgery,12 patients were treated with external beam radiotherapy,56 patients with chemoradiotherapy (CRT),and 17 patients with chemotherapy.Overall survival (OS),local recurrence,and toxicities were retrospectively analyzed.The Kaplan-Meier method was used to calculate survival rates,the log-rank test was used for survival difference analysis and univariate prognostic analysis,and the Cox model was used for multivariate prognostic analysis.Results The follow-up rate was 100％.The median OS time was 10.3 months,and the 2-year OS rate was 22％.The median progression-fiee survival (PFS) time was 6.3 months,and the 2-year PFS rate was 9.9％.The cancer-specific survival (CSS) time was 11.2 months,and the 2-year CSS rate was 23.6％.In the patients treated with IORT alone at doses of＜15 Gy,15 Gy and＞15 Gy,the median OS times were 6.2 months vs.9.1 months vs.22.2 months,and the 1-year OS rates were 10.0％ vs.39.6％ vs.74.4％ (P=0.000).Among the patients receiving postoperative adjuvant therapy,those treated with IORT+CRT had the best survival,with a median OS time of 11.6 months (P=0.033).The univariate analysis showed that IORT dose (P =0.000),tumor size (P =0.006),and IORT applicator diameter (P =0.007) were prognostic factors.The multivariate analysis showed that IORT dose (P=0.000) and IORT combined with CRT (P=0.006) were independent prognostic factors.Conclusions IORT with electron beam is an effective and safe treatment strategy for unresectable locally advanced pancreatic cancer.After protecting surrounding organs,increasing the IORT dose can improve the survival.IORT combined with CRT should be recommended because it improves survival for unresectable locally advanced pancreatic cancer without increasing toxicities.