放射線肺炎의 發生과 促進要因에 關한 考察

Abstract

肺組織은 放射線耐容力이 비교적 낮아 放射線治療時에 항시 考慮되어야할 制限臟器임에도 불구하고, 近來에 肺癌 및 乳房癌이 현저히 增加하여 肺部位의 放射線治療가 많이 施行되므로 照射後 倂發하는 肺損傷인 放射線肺炎파 纖維化의 發生頻度 및 進行이 臨床的으로 重要한 問題로 대두되고 있다. 本 硏究는 1983年 10月부터 1985年 9月까지 仁濟醫科大學附屬 서울白病院 治療放射線科에서 肺癌, 乳房癌 및 縱隔洞癌으로 肺를 포함하여 隣接周圍臟器에 放射線治療를 받은 66例를 硏究對象으로 하여 放射線肺炎의 發生頻度와 促進要因들을 分析하여 다음과 같은 結論을 얻었다. 1. 66例中 26例(39%)에서 放射線肺炎이 脚部 X-線像에서 觀察되었고, 이중 13例에서는 臨床症狀으로 呼吸困難, 마른기침 및 徵熱을 呼訴하였다. 2. 放射線肺炎의 發生時期는 放射線治療後 3個月 以內가 77% 5個月 以內가 96%에 이르렀다. 3 .放射線肺炎 發生과 放射線照射量과의 關係는 照射線量이 增加함에 따라 放射線肺炎 發生이 上昇하였다. 즉 1200∼1399 rets 照射時에는 14%, 1400∼1599 rets 照射時에는 32%, 그리고 1600∼1799 rets 照射時에는 52%, 1800 rets 以上 照射한 2例에서 모두 放射線肺炎이 發生하였다. 4. 放射線肺炎의 發生과 照射野에 包含된 肺容積과의 關係는 乳房癌 및 縱隔洞癌에서도 肺癌患者의 경우와 같이 肺容積이 增加할수록 放射線肺炎 發生이 上昇하였으나 統計學的인 有意性은 낮았다. 5. 放射線肺炎 發生과 年齡의 相關關係는 有意性이 없었다. 6 .抗癌化學療法劑 投與와 放射線肺炎 發生의 關係는 抗癌化學劑治療가 放射線治療前 또는 同時에 倂行된 경우에는 放財線肺炎 發生이 67%,이에 比해 放射線治療後 抗癌化學劑가 投與된 경우에는 25%의 患者에서 放射線肺炎이 發生되어 統計學的 意義가 있었다. 7. 放射線肺炎 發生과 吸煙의 相關關係는 吸煙者에서는 45%, 非吸煙者에서는 36% 發生되어 統計的으로 有意性이 없었다. 8 .其他 肺疾患과의 相關關係에 있어서는 肺疾患이 있었던 患者에서는 47%, 없었던 患者에서는 37%에서 發生하였으나 統計學的인 意義는 없었다.;With the introduction of X-rays of higher energy that have higher penetrability, it has become possible to treat the deep-seated tumor with increased local control rate. But at the same time it has increased the damage to the deep-seated organs, especially to the lung which is known to be the less radiotolerable tissue in the body. This study analyses the 66 patients who were exposed to the irradiation of the lung, and examines the development of radiation pneumonitis and its related factors. The results of the study are summarized as fellows: 1. The 66 patients were consisted of 40 cases of lung cancer, 15 cases of breast cancer and 11 cases of mediastinal tumors. There were 37 males and 29 females with the male to female ratio 1. 3 : 1. A male to female ratio in the lung cancer was 3:1. 2. Among 66 patients, 26 patients (39%) developed the radiographical changes of acute radiation pneumonitis and 13 out of 26 patients (50%) showed the clinical features of acute radiation pneumonitis. 3. The onset of acute radiation pneumonitis ranged from 10 days to 6 months after the completion of radiotherapy. 77% of developments of the radiation pneumonitis occurred within 3 months and 96% within 5 months. 4. There was a statistically significant close relationship between the development of radiation pneumonitis and the radiation dose. 5. As the irradiated lung volume increased, the development of radiation pneumonitis increased . But the statistical significance was not strong. 6. The increased incidence of radiation pneumonitis was observed when the chemotherapy was given before or concomittantly with radiotherapy. 7. There was no significant correlation between the development of radiation pneumonitis and the age, smoking and the presence of underlying lung disease.