pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2020-30-4-413-420pulmo-2147Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESЛегочная токсичность, индуцированная блеомицином, у больных лимфомой ХоджкинаBleomycin-induced pulmonary toxicity in Hodgkin`s lymphoma patientshttps://orcid.org/0000-0002-7056-0527ШахтаринаС. В.ShakhtarinaS. V.

Шахтарина Светлана Васильевна – доктор медицинских наук, ведущий научный сотрудник

249036, Калужская обл., Обнинск, ул. Королева, 4

Svetlana V. Shakhtarina, Doctor of Medicine, Leading Researcher

ul. Koroleva 4, Kaluga Region, Obninsk, 249036

shakhtarina@mrrc.obninsk.ruhttps://orcid.org/0000-0002-6798-6076ДаниленкоА. А.DanilenkoA. A.

Даниленко Анатолий Александрович – доктор медицинских наук, старший научный сотрудник

249036, Калужская обл., Обнинск, ул. Королева, 4

Anatoliy A. Danilenko, Doctor of Medicine, Senior Researcher

ul. Koroleva 4, Kaluga Region, Obninsk, 249036

danilenkoanatol@mail.ruАфанасоваН. В.AfanasovaN. V.

Афанасова Нина Васильевна – кандидат медицинских наук, старший научный сотрудник

249036, Калужская обл., Обнинск, ул. Королева, 4

Nina V. Afanasova, Candidate of Medicine, Senior Researcher

ul. Koroleva 4, Kaluga Region, Obninsk, 249036

shakhtarina@mrrc.obninsk.ruhttps://orcid.org/0000-0002-0023-4216ФалалееваН. А.FalaleevaN. A.

Фалалеева Наталья Александровна – доктор медицинских наук, заведующая отделом лекарственного лечения злокачественных новообразований

249036, Калужская обл., Обнинск, ул. Королева, 4

Natal'ya A. Falaleeva, Doctor of Medicine, Head of the Department of Drug Treatment of Malignant Neoplasms

ul. Koroleva 4, Kaluga Region, Obninsk, 249036

falaleeva-n@mail.ruИвановС. А.IvanovS. A.

Иванов Сергей Анатольевич – доктор медицинских наук, директор

249036, Калужская обл., Обнинск, ул. Королева, 4

Sergey A. Ivanov, Doctor of Medicine, Director

ul. Koroleva 4, Kaluga Region, Obninsk, 249036

oncourolog@gmail.comКапринА. Д.KaprinA. D.

Каприн Андрей Дмитриевич – доктор медицинских наук, профессор, академик Российской академии наук, генеральный директор

249036, Калужская обл., Обнинск, ул. Королева, 4

Andrey D. Kaprin, Doctor of Medicine, Professor, Academician of the Russian Academy of Sciences, General Director

ul. Koroleva 4, Kaluga Region, Obninsk, 249036

contact@nmicr.ruМедицинский радиологический научный центр имени А.Ф.Цыба – филиал Федерального государственного бюджетного учреждения «Национальный медицинский исследовательский центр радиологии» Министерства здравоохранения Российской ФедерацииРоссияA.F.Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center, Healthcare Ministry of RussiaRussian Federation202017102020304413420Copyright © Шахтарина С.В., Даниленко А.А., Афанасова Н.В., Фалалеева Н.А., Иванов С.А., Каприн А.Д., 20202020Шахтарина С.В., Даниленко А.А., Афанасова Н.В., Фалалеева Н.А., Иванов С.А., Каприн А.Д.Shakhtarina S.V., Danilenko A.A., Afanasova N.V., Falaleeva N.A., Ivanov S.A., Kaprin A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/2147

Блеомицин, входящий в большинство схем химиотерапии (ХТ) больных лимфомой Ходжкина (ЛХ), обладает легочной токсичностью. Также известны осложнения облучения области средостения. Синергический эффект сочетания лучевой терапии и блеомицина рассматривается в литературе значительно реже и преимущественно при использовании суммарных очаговых доз (СОД) об лучения 36– 40 Гр. С 1998 г. при химиолучевой терапии (ХЛТ) больных ЛХ используются субрадикальные СОД облучения 20–30 Гр.

Целью исследования явилась оценка легочной токсичности у больных ЛХ при ХЛТ – сочетании ХТ в режиме ABVD и облучения средостения в СОД 20–30 Гр.

Материалы и методы

Материалы и методы. Обследованы больные ЛХ (n = 142), получившие ХТ ABVD и облучение средостения в СОД 20–30 Гр. Проанализированы классические и цифровые обзорные рентгенограммы, линейные и цифровые компьютерные томограммы органов грудной клетки, выполненные на различных этапах лечения и процесса наблюдения.

Результаты

Результаты. Изменения в легких обнаружены у 39 (27,5 %) из 142 больных в виде патологического легочного рисунка (интерстициальный пульмонит). В 10 (25,6 %) случаях определялась инфильтрация очагового или сливного типов (очаговый, сливной пульмонит), (7 % пациентов всей группы). Клинические проявления блеомицинового пульмонита (БП) отмечены у 6 (15,4 %) больных. При сроках наблюдения до 60 мес. фиброзные изменения в легких вне полей облучения отсутствовали. Частота лучевого пульмонита (ЛП) составила 17,6 %, лучевого фиброза – 35,9 %. Отмечены также фиброзные изменения преимущественно I степени (94,1 %). У больных ЛХ, перенесших БП, частота ЛП составила 17 (43,6 %) из 39 пациентов, лучевого фиброза – 23 (58,9 %), у лиц, не перенесших БП, – 9 (8,7 %) и 28 (27,2 %) из 103 больных соответственно) (p < 0,001).

Заключение

Заключение. Установлено достоверно значимое повышение частоты ЛП и лучевого фиброза у больных ЛХ, перенесших БП.

Bleomycin used as part of many chemo-therapeutic programs for treating Hodgkin lymphoma is associated with pulmonary toxicity. Development of complications after mediastinal radiotherapy is also well-known. However, the synergistic effect of the combination of radiotherapy and bleomycin is considered in the literature much less frequently and mainly when using the total focal doses (SOD) of 36 – 40 Gy. Since 1998 the chemo-radiotherapeutic regimens applied to the treatment of Hodgkin lymphoma in the MRRC (Obninsk) has involved subradical TTD of 20 – 30 Gy. The goal of the study is to evaluate pulmonary toxicity in Hodgkin lymphoma patients treated with chemo-radiotherapy involving ABVD and mediastinal treatment with TTD of 20 – 30 Gy.

Methods

Methods. A series of 142 Hodgkin lymphoma patients received ABVD and mediastinal radiotherapy at the TTD 20 – 30 Gy. Conventional film and digital chest X-rays, linear and digital tomograms taken at different stages of treatment and follow up were analysed.

Results

Results. Changes in lungs in the form of a pathologic pulmonary pattern (interstitial pneumonitis) were seen in 39 (27.5%) of 142 patients. In 10 (25.6%) of 39 patients focal or confluent pneumonitis infiltration were found, that was 7% of the whole study group. Clinical evidence of bleomycin-induced pneumonitis was found in 6 (15.4%) of 39 patients. With follow-up terms up to 60 months fibrotic changes in lungs were absent. The occurrence of radiation pneumonitis was 17.6%, radiation fibrosis – 35.9%. Fibrotic changes were mainly grade 1 (94.1%). In HL patients with bleomycin-induced pneumonitis the occurrence of radiation pneumonitis was 43.6% (17 of 39 patients), radiation fibrosis – 58.9% (23 of 39 patients) while the corresponding figures for patients who did not have bleomycin-induced pneumonitis were 8.7% (9 of 103 patients) and 27.2% (28 of 103 patients), respectively (p < 0.001).

Conclusion

Conclusion. A statistically significant increase in occurrence of radiation pneumonitis and radiation fibrosis was defined in HL patients who suffered bleomycin-induced pneumonitis.

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The authors declare that there are no conflicts of interest present.