尼達尼布治療放射性肺損傷一例并文獻復習_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

張凌云 ¹ , 田飛 ² , 龔正 ¹ , 張敏 ¹ , 王玲 ¹ , 向軍 ¹ , 王巍 ¹ , 陸志凌 ¹ , 向光明 ¹ ,  高寶安 ¹

1. ;
2. ;

Corresponding?author：

高寶安, Email: springxiaozhu@163.com

Keywords：

尼達尼布; 放射性粒子; 放射性肺損傷; 療效

DOI：

10.7507/1671-6205.202008044

Video：

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目的探討放射性肺損傷的發病機制、臨床表現、影像學特點、可能的治療手段及預后。方法分析 1 例確診為肺鱗癌合并放射性肺損傷并接受尼達尼布治療患者的臨床資料，結合相關文獻復習，總結其臨床特點、治療過程及預后。結果本例為 72 歲男性肺鱗癌患者，經同步放化療和放射性粒子植入術后并發放射性肺損傷，主要癥狀為活動后氣促，胸部 CT 表現為雙肺磨玻璃影和網格影，右下肺顯著。經尼達尼布規范化治療 4 個月后，臨床癥狀以及影像學都明顯緩解，隨訪 1 年，病情持續穩定，未見明顯不良反應。文獻復習發現，放射性肺損傷患者臨床上多表現為干咳、發熱及呼吸困難，重癥患者可危及生命，影像學多表現為放射靶區的片狀影，多以肺實變伴支氣管充氣征為主。最常用的治療藥物為糖皮質激素，也有少部分患者對激素治療反應不佳，新的治療手段仍在探索之中。結論放射性肺損傷是惡性腫瘤患者放療過程中較常見的并發癥，但目前治療手段有限，尼達尼布作為一種新型的小分子靶向藥，可能對放射性肺損傷具有一定的修復作用。

Citation： 張凌云, 田飛, 龔正, 張敏, 王玲, 向軍, 王巍, 陸志凌, 向光明, 高寶安. 尼達尼布治療放射性肺損傷一例并文獻復習. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(8): 584-587. doi: 10.7507/1671-6205.202008044 Copy

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25.	Jin H, Yoo Y, Kim Y, et al. Radiation-induced lung fibrosis: preclinical animal models and therapeutic strategies. Cancers (Basel), 2020, 12(6): 1561.
26.	Westbury CB, Yarnold JR. Radiation fibrosis--current clinical and therapeutic perspectives. Clin Oncol (R Coll Radiol), 2012, 24(10): 657-672.
27.	劉文秀, 楊娟, 曹博, 等. 甲磺酸伊馬替尼對放射性肺炎小鼠肺部氧化應激指標及轉化生長因子-β1 表達影響的研究. 中國呼吸與危重監護雜志, 2017, 16(5): 446-450.
28.	De Ruysscher D, Granton PV, Lieuwes NG, et al. Nintedanib reduces radiation-induced microscopic lung fibrosis but this cannot be monitored by CT imaging: a preclinical study with a high precision image-guided irradiator. Radiother Oncol, 2017, 124(3): 482-487.

1. Bledsoe TJ, Nath SK, Decker RH. Radiation pneumonitis. Clin Chest Med, 2017, 38(2): 201-208.
2. Zhang P, Yan H, Wang S, et al. Post-radiotherapy maintenance treatment with fluticasone propionate and salmeterol for lung cancer patients with grade Ⅲ radiation pneumonitis: a case report. Medicine (Baltimore), 2018, 97(21): e10681.
3. Kawakami H, Miyabayashi T, Tsubata C, et al. Spontaneous resolution of thoracic radiation therapy-induced organizing pneumonia: a case series. Respir Med Case Rep, 2019, 26: 180-184.
4. Wolf MS, Chadha AD, Carroll CM, et al. Unusual progression and subsequent improvement in cystic lung disease in a child with radiation-induced lung injury. Pediatr Radiol, 2015, 45(7): 1086-1090.
5. Conway JL, Long K, Ploquin N, et al. Unexpected symptomatic pneumonitis following breast tangent radiation: a case report. Cureus, 2015, 7(10): e363.
6. Hu Y, Li J, Su X. Fatal pneumonitis associated with postoperative intensity-modulated radiotherapy in lung cancer: case report and review. Oncol Lett, 2013, 5(2): 714-716.
7. Sakurai K, Kubo N, Shibutani M, et al. Five cases of severe radiation pneumonitis after chemoradiotherapy for esophageal cancer. Gan To Kagaku Ryoho, 2013, 40(12): 2139-2142.
8. Muraoka T, Bandoh S, Fujita J, et al. Corticosteroid refractory radiation pneumonitis that remarkably responded to cyclosporin A. Intern Med, 2002, 41(9): 730-703.
9. B?lke E, Matuschek C. Images in clinical medicine. Radiation pneumonitis after radiotherapy for breast cancer. N Engl J Med, 2009, 361(27): e65.
10. Miyagawa T, Mochizuki Y, Nakahara Y, et al. A case of severe radiation pneumonitis--a trial of plasma exchange. Nihon Kokyuki Gakkai Zasshi, 2009, 47(6): 481-485.
11. Huang Y, Zhang W, Yu F, et al. The cellular and molecular mechanism of radiation-induced lung injury. Med Sci Monit, 2017, 23: 3446-3450.
12. Torre-Bouscoulet L, Mu?oz-Monta?o WR, Martínez-Brise?o D, et al. Abnormal pulmonary function tests predict the development of radiation-induced pneumonitis in advanced non-small cell lung Cancer. Respir Res, 2018, 19(1): 72.
13. Guilbault C, Garant A, Faria S, et al. Long-term outcomes of induction carboplatin and gemcitabine followed by concurrent radiotherapy with low-dose paclitaxel and gemcitabine for stage Ⅲ non-small-cell lung cancer. Clin Lung Cancer, 2017, 18: 565-571.
14. Chen Z, Wu Z, Ning W. Advances in molecular mechanisms and treatment of radiation-induced pulmonary fibrosis. Transl Oncol, 2019, 12(1): 162-169.
15. Richeldi L, du Bois RM, Raghu G, et al. Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis. N Engl J Med, 2014, 370(22): 2071-2082.
16. Distler O, Highland KB, Gahlemann M, et al. Nintedanib for systemic sclerosis-associated interstitial lung disease. N Engl J Med, 2019, 380(26): 2518-2528.
17. Flaherty KR, Wells AU, Cottin V, et al. Nintedanib in progressive fibrosing interstitial lung diseases. N Engl J Med, 2019, 381(18): 1718-1727.
18. Capelletto E, Migliorino MR, Morabito A, et al. Final results of the SENECA (SEcond line NintEdanib in non-small cell lung CAncer) trial. Lung Cancer, 2019, 134: 210-217.
19. Forster M, Hackshaw A, De Pas T, et al. A phase I study of nintedanib combined with cisplatin/gemcitabine as first-line therapy for advanced squamous non-small cell lung cancer (LUME-Lung 3). Lung Cancer, 2018, 120: 27-33.
20. Henkenberens C, Janssen S, Lavae-Mokhtari M, et al. Inhalative steroids as an individual treatment in symptomatic lung cancer patients with radiation pneumonitis grade Ⅱ after radiotherapy - a single-centre experience. Radiat Oncol, 2016, 11: 12.
21. Hanania AN, Mainwaring W, Ghebre YT, et al. Radiation-induced lung injury: assessment and management. Chest, 2019, 156(1): 150-162.
22. Jackson IL, Vujaskovic Z, Down JD. A further comparison of pathologies after thoracic irradiation among different mouse strains: finding the best preclinical model for evaluating therapies directed against radiation-induced lung damage. Radiat Res, 2011, 175: 510-518.
23. Otani K, Nishiyama K, Ito Y, et al. Steroid treatment increases the recurrence of radiation-induced organizing pneumonia after breast-conserving therapy. Cancer Med, 2014, 3(4): 947-953.
24. Wollin L, Distler JHW, Redente EF, et al. Potential of nintedanib in treatment of progressive fibrosing interstitial lung diseases. Eur Respir J, 2019, 54(3): 1900161.
25. Jin H, Yoo Y, Kim Y, et al. Radiation-induced lung fibrosis: preclinical animal models and therapeutic strategies. Cancers (Basel), 2020, 12(6): 1561.
26. Westbury CB, Yarnold JR. Radiation fibrosis--current clinical and therapeutic perspectives. Clin Oncol (R Coll Radiol), 2012, 24(10): 657-672.
27. 劉文秀, 楊娟, 曹博, 等. 甲磺酸伊馬替尼對放射性肺炎小鼠肺部氧化應激指標及轉化生長因子-β1 表達影響的研究. 中國呼吸與危重監護雜志, 2017, 16(5): 446-450.
28. De Ruysscher D, Granton PV, Lieuwes NG, et al. Nintedanib reduces radiation-induced microscopic lung fibrosis but this cannot be monitored by CT imaging: a preclinical study with a high precision image-guided irradiator. Radiother Oncol, 2017, 124(3): 482-487.

Chinese Journal of Respiratory and Critical Care Medicine

尼達尼布治療放射性肺損傷一例并文獻復習

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