References

pulmo

Пульмонология

PULMONOLOGIYA

0869-01892541-9617

Scientific and Practical Journal “PULMONOLOGIYA” LLC

10.18093/0869-0189-2024-34-4-471-477

pulmo-4366

Research Article

ПЕРЕДОВАЯ СТАТЬЯ

EDITORIAL

Постлучевое поражение легких при злокачественных новообразованиях органов грудной клетки: современное состояние проблемы, направления профилактики и реабилитации

Radiation-induced lung injury in malignant thoracic neoplasms: current state of the problem, trends in prevention and rehabilitation

https://orcid.org/0000-0002-3219-0107

Логинова

И. Ю.

Loginova

I. Yu.

Логинова Ирина Юрьевна – к. б. н., старший научный сотрудник лаборатории клинической физиологии научно-исследовательского отдела анестезиологии и реаниматологии.

630055, Новосибирск, ул. Речкуновская, 15

Тел.: (383) 347-60-66

Irina Yu. Loginova - Candidate of Biology, Senior Researcher, Laboratory of Clinical Physiology, Research Department of Anesthesiology and Reanimatology, Federal State Budgetary Institution “Academician E.Meshalkin National Medical Research Center”, Healthcare Ministry of the Russian Federation.

Rechkunovskaya ul. 15, Novosibirsk, 630055

Tel.: (383) 347-60-66

i_loginova@meshalkin.ru

https://orcid.org/0000-0001-8488-0858

Каменская

О. В.

Kamenskaya

O. V.

Каменская Оксана Васильевна – д. м. н., заведующая лабораторией клинической физиологии научно-исследовательского отдела анестезиологии и реаниматологии.

630055, Новосибирск, ул. Речкуновская, 15

Тел.: (383) 347-60-66

Oksana V. Kamenskaya - Doctor of Medicine, Head of the Laboratory of Clinical Physiology, Research Department of Anesthesiology and Reanimatology, Federal State Budgetary Institution “Academician E. Meshalkin National Medical Research Center”, Healthcare Ministry of the Russian Federation.

Rechkunovskaya ul. 15, Novosibirsk, 630055

Tel.: (383) 347-60-66

o_kamenskaya@meshalkin.ru

https://orcid.org/0000-0002-0887-0946

Даниленко

С. О.

Danilenko

S. O.

Даниленко Сергей Олегович – младший научный сотрудник лаборатории клинической физиологии научно-исследовательского отдела анестезиологии и реаниматологии.

630055, Новосибирск, ул. Речкуновская, 15

Тел.: (383) 347-60-66

Sergey O. Danilenko - Junior Researcher, Laboratory of Clinical Physiology, Research Department of Anesthesiology and Reanimatology, Federal State Budgetary Institution “Academician E. Meshalkin National Medical Research Center”, Healthcare Ministry of the Russian Federation.

Rechkunovskaya ul. 15, Novosibirsk, 630055

Tel.: (383) 347-60-66

danilenko_s@meshalkin.ru

https://orcid.org/0000-0003-2845-930X

Клинкова

А. С.

Klinkova

A. S.

Клинкова Ася Станиславовна – к. м. н., научный сотрудник лаборатории клинической физиологии научно-исследовательского отдела анестезиологии и реаниматологии.

630055, Новосибирск, ул. Речкуновская, 15

Тел.: (383) 347-60-66

Asya S. Klinkova - Candidate of Medicine, Researcher, Laboratory of clinical physiology, Department of Anesthesiology and Reanimatology, Federal State Budgetary Institution “Academician E. Meshalkin National Medical Research Center”, Healthcare Ministry of the Russian Federation.

Rechkunovskaya ul. 15, Novosibirsk, 630055

Tel.: (383) 347-60-66

a_klinkova@meshalkin.ru

https://orcid.org/0000-0002-0061-2205

Поротникова

С. С.

Porotnikova

S. S.

Поротникова Светлана Сергеевна – младший научный сотрудник лаборатории клинической физиологии научно-исследовательского отдела анестезиологии и реаниматологии.

630055, Новосибирск, ул. Речкуновская, 15

Тел.: (383) 347-60-66

Svetlana S. Porotnikova - Junior Researcher, Laboratory of clinical physiology, Department of Anesthesiology and Reanimatology, Federal State Budgetary Institution “Academician E. Meshalkin National Medical Research Center”, Healthcare Ministry of the Russian Federation.

Rechkunovskaya ul. 15, Novosibirsk, 630055

Tel.: (383) 347-60-66

porotnikova_s@meshalkin.ru

https://orcid.org/0000-0003-3047-4613

Жеравин

А. А.

Zheravin

A. A.

Жеравин Александр Александрович – к. м. н., ведущий научный сотрудник Института онкологии и нейрохирургии.

630055, Новосибирск, ул. Речкуновская, 15

Тел.: (383) 347-60-40

Alexander A. Zheravin - Candidate of Medicine, Leading Researcher, Institute of Oncology and Neurosurgery, Federal State Budgetary Institution “Academician E. Meshalkin National Medical Research Center”, Healthcare Ministry of the Russian Federation.

Rechkunovskaya ul. 15, Novosibirsk, 630055

Tel.: (383) 347-60-40

a_zheravin@meshalkin.ru

https://orcid.org/0000-0001-8366-6083

Красильников

С. Э.

Krasilnikov

S. E.

Красильников Сергей Эдуардович – д. м. н., директор Института онкологии и нейрохирургии.

630055, Новосибирск, ул. Речкуновская, 15

Тел.: (383) 347-60-40

Sergey E. Krasilnikov - Doctor of Medicine, Director, Institute of Oncology and Neurosurgery, Federal State Budgetary Institution “Academician E. Meshalkin National Medical Research Center”, Healthcare Ministry of the Russian Federation.

Rechkunovskaya ul. 15, Novosibirsk, 630055

Tel.: (383) 347-60-40

krasilnikov_s@meshalkin.ru

https://orcid.org/0000-0001-9818-8678

Чернявский

А. М.

Chernyavsky

A. M.

Чернявский Александр Михайлович – д. м. н., профессор, член-корр. Российской академии наук, директор.

630055, Новосибирск, ул. Речкуновская, 15

Тел.: (383) 347-60-40

Alexander M. Chernyavsky - Doctor of Medicine, Professor, Corresponding member of Russian Academy of Sciences, Director, Federal State Budgetary Institution “Academician E. Meshalkin National Medical Research Center”, Healthcare Ministry of the Russian Federation.

Rechkunovskaya ul. 15, Novosibirsk, 630055

Tel.: (383) 347-60-40

a_cherniavsky@meshalkin.ru

Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени академика Е.Н. Мешалкина» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Institution “Academician E. Meshalkin National Medical Research Center”, Healthcare Ministry of the Russian FederationRussian Federation

2024

14062024

344471477

2024

Логинова И.Ю., Каменская О.В., Даниленко С.О., Клинкова А.С., Поротникова С.С., Жеравин А.А., Красильников С.Э., Чернявский А.М.

Loginova I.Y., Kamenskaya O.V., Danilenko S.O., Klinkova A.S., Porotnikova S.S., Zheravin A.A., Krasilnikov S.E., Chernyavsky A.M.

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/4366

Постлучевое поражение легких (ПЛПЛ) является одним из наиболее серьезных осложнений лучевой терапии у пациентов с онкологическими заболеваниями органов грудной клетки. ПЛПЛ возникает в результате накопления дозы облучения в легочной ткани и может привести к развитию различных патологических изменений в легких, таких как фиброз, пневмонит и легочная гипертензия. При ПЛПЛ значительно снижается качество жизни пациента и ухудшается прогноз заболевания. Целью обзора литературных источников является анализ причин возникновения ПЛПЛ. Приводится описание основных клинических проявлений и методов диагностики, обсуждаются возможности лечения и профилактики данного осложнения. Заключение. За последние годы достигнут значительный прогресс в понимании многофакторных патофизиологических механизмов развития ПЛПЛ. Сохраняется необходимость дальнейшего изучения специфических прогностических факторов ПЛПЛ, заслуживают внимания неинвазивные методы диагностики функционального состояния респираторной системы. Перспективными направлениями будущих исследований представляются разработка индивидуального клинического мониторинга и мониторинга функции легких, специфических методов лечения, предотвращения и уменьшения последствий ПЛПЛ с целью создания единой системы профилактики и реабилитации ПЛПЛ в процессе комплексного лечения.

Radiation-induced lung injury is one of the most serious complications of radiation therapy in patients with malignant thoracic neoplasms. It results from accumulation of radiation dose in the lung tissue and can lead to development of various pathological changes in the lungs, such as fibrosis, pneumonitis and pulmonary hypertension. Post-radiation lung injury can significantly reduce the patient’s quality of life and worsen the prognosis. Aim. This literature review analyzes the causes of radiation-induced lung injury, describes the main clinical manifestations and diagnostic methods, and also discusses the possibilities of treatment and prevention of this complication. Conclusion. In recent years, significant progress has been made in understanding the multifactorial pathophysiological mechanisms of radiation-induced lung injury. There is still a need for further studies of the specific prognostic factors. Non-invasive methods to diagnose the functional state of the respiratory system also deserve attention. Promising areas of future research and development include individual clinical monitoring and monitoring of lung function, specific methods of treatment, prevention and reduction of the consequences of radiation-induced lung injury. Development in this areas will help to create a unified system of prevention and rehabilitation of radiation-induced lung injury as part of complex treatment.

лучевая терапияпостлучевое поражение легкихфункция внешнего дыхания

radiation therapyradiation-induced lung injuryexternal respiratory function

Работа выполнена в рамках государственного задания Министерства здравоохранения Российской Федерации № 121031300227-2.

This work was carried out as part of the state assignment of the Ministry of Health of the Russian Federation No.121031300227-2.

References1

Фаттахов Т., Миронова А., Пянкова А.И., Шахзадова А.О. Смертность от новообразований в России в 1965–2019: основные структурные изменения и тенденции. Сибирский онкологический журнал. 2021; 20 (4): 5–20. DOI: 10.21294/1814-4861-2021-20-4-5-20.

Fattakhov T.A., Mironova A.A., Pyankova A.I., Shahzadova A.O. [Cancer mortality in Russia for the period of 1965–2019: main structural changes and trends]. Sibirskiy onkologicheskiy zhurnal. 2021; 20 (4): 5–20. DOI: 10.21294/1814-4861-2021-20-4-5-20 (in Russian).

Cancer Today: International Association of Cancer Registries (IACR). 2020. Cancer fact sheet: all cancer. Available at: https://gco.iarc.fr/today/en

Franceschini D., Comito T., Di Gallo A. et al. Stereotactic body radiation therapy for lung and liver oligometastases from breast cancer: toxicity data of a prospective non-randomized phase II trial. Curr. Oncol. 2022; 29 (10): 7858–7867. DOI: 10.3390/CURRONCOL29100621.

Polgár C., Kahán Z., Ivanov O. et al. Radiotherapy of breast cancer – professional guideline 1st central-eastern European professional consensus statement on breast cancer. Pathol. Oncol. Res. 2022; 28: 1610378. DOI: 10.3389/pore.2022.1610378.

Гоголин Д.В., Гулидов И.А., Медведева К.Е. И др. Нетрадиционные режимы фракционирования в лечении неоперабельного рака легкого. Сибирский онкологический журнал. 2019; 18 (4): 21–26. DOI: 10.21294/1814-4861-2019-18-4-21-26.

Gogolin D.V., Gulidov I.A., Medvedeva K.E. et al. [Unconventional fractionation radiotherapy regimens in treatment of inoperable lung cancer]. Sibirskiy onkologicheskiy zhurnal. 2019; 18 (4): 21–26. DOI: 10.21294/1814-4861-2019-18-4-21-26 (in Russian).

Сычева М.Г., Грушина Т.И. Фармакотерапия радиационно-индуцированных повреждений легких у онкологических больных. Пульмонология. 2013; (5): 57–60. DOI: 10.18093/0869-0189-2013-0-5-57-60.

Sycheva M.G., Grushina T.I. [Pharmacotherapy of radiation-induced pulmonary lesions in oncologic patients]. Pul'monologiya. 2013; (5): 57–60. DOI: 10.18093/0869-0189-2013-0-5-57-60 (in Russian).

Konkol M., Śniatała P., Milecki P. Radiation-induced lung injury – what do we know in the era of modern radiotherapy? Rep. Pract. Oncol. Radiother. 2022; 27 (3): 552–565. DOI: 10.5603/RPOR.A2022.0046.

Straub J.M., New J., Hamilton C.D et al. Radiation-induced fibrosis: mechanisms and implications for therapy. J. Cancer Res. Clin. Oncol. 2015; 141 (11): 1985–1994. DOI: 10.1007/S00432-015-1974-6.

Käsmann L., Dietrich A., Staab-Weijnitz C.A. et al. Radiation-induced lung toxicity – cellular and molecular mechanisms of pathogenesis, management, and literature review. Radiat. Oncol. 2020; 15 (1). DOI: 10.1186/S13014-020-01654-9.

Podlesnikar T., Berlot B., Dolenc J. et al. Radiotherapy-induced cardiotoxicity: the role of multimodality cardiovascular imaging. Front. Cardiovasc. Med. 2022; 9: 887705. DOI: 10.3389/FCVM.2022.887705.

Hanania A.N., Mainwaring W., Ghebre Y.T. et al. Radiation-induced lung injury: assessment and management. Chest. 2019; 156 (1): 150–162. DOI: 10.1016/J.CHEST.2019.03.033.

Wang Z., Huo B., Wu Q. et al. The role of procalcitonin in differential diagnosis between acute radiation pneumonitis and bacterial pneumonia in lung cancer patients receiving thoracic radiotherapy. Sci. Rep. 2020; 10 (1): 2941. DOI: 10.1038/s41598-020-60063-w.

Zhong D., Wu C., Bai J. et al. Comparative diagnostic efficacy of serum Krebs von den Lungen-6 and surfactant D for connective tissue disease-associated interstitial lung diseases: a meta-analysis. Medicine (Baltimore). 2020; 99 (16): e19695. DOI: 10.1097/MD.0000000000019695.

Arroyo-Hernández M., Maldonado F., Lozano-Ruiz F. et al. Radiation-induced lung injury: current evidence. BMC Pulm. Med. 2021; 21 (1): 9. DOI: 10.1186/S12890-020-01376-4.

Liao Z., Lee J.J., Komaki R. et al. Bayesian adaptive randomization trial of passive scattering proton therapy and intensity-modulated photon radiotherapy for locally advanced non-small-cell lung cancer. J. Clin. Oncol. 2018; 36 (18): 1813–1822. DOI: 10.1200/JCO.2017.74.0720.

Shintani T., Kishi N., Matsuo Y. et al. Incidence and risk factors of symptomatic radiation pneumonitis in non-small-cell lung cancer patients treated with concurrent chemoradiotherapy and consolidation durvalumab. Clin. Lung Can. 2021; 22 (5): 401–410. DOI: 10.1016/J.CLLC.2021.01.017.

Hu X., Bao Y., Xu Y. et al. Final report of a prospective randomized study on thoracic radiotherapy target volume for limited-stage small cell lung cancer with radiation dosimetric analyses. Cancer. 2020; 126 (4): 840–849. DOI: 10.1002/CNCR.32586.

Schytte T., Bentzen S.M., Brink C., Hansen O. Changes in pulmonary function after definitive radiotherapy for NSCLC. Radiother. Oncol. 2015; 117 (1): 23–28. DOI: 10.1016/J.RADONC.2015.09.029.

Huang Y., Zhang W., Yu F., Gao F. The cellular and molecular mechanism of radiation-induced lung injury. Med. Scie. Monit. 2017; 23: 344–3450. DOI: 10.12659/MSM.902353.

Lierova A., Jelicova M., Nemcova M. et al. Cytokines and radiation-induced pulmonary injuries. J. Radiat. Res. 2018; 59 (6): 709–753. DOI: 10.1093/JRR/RRY067.

Bime C., Casanova N.G., Nikolich-Zugich J. et al. Strategies to DAMPen COVID-19-mediated lung and systemic inflammation and vascular injury. Trans. Res. 2021; 232: 37–48. DOI: 10.1016/J.TRSL.2020.12.008.

Cytlak U.M., Dyer D.P., Honeychurch J. et al. Immunomodulation by radiotherapy in tumour control and normal tissue toxicity. Nat. Rev. Immunol. 2022; 22 (2): 124–138. DOI: 10.1038/S41577-021-00568-1.

Wang T., Mathew B., Wu X. et al. Nonmuscle myosin light chain kinase activity modulates radiation-induced lung injury. Pulm. Circ. 2016; 6 (2): 234–239. DOI: 10.1086/686491.

Yan Z., Ao X., Liang X. et al. Transcriptional inhibition of miR-486-3p by BCL6 upregulates Snail and induces epithelial-mesenchymal transition during radiation-induced pulmonary fibrosis. Respir. Res. 2022; 23 (1): 104. DOI: 10.1186/S12931-022-02024-7.

Sato H., Ebi J., Tamaki T. Incidence of organizing pneumonia after whole-breast radiotherapy for breast cancer, and risk factor analysis. J. Radiat. Res. 2018; 59 (3): 298–302. DOI: 10.1093/JRR/RRY001.

Giuranno L., Ient J., De Ruysscher D., Vooijs M.A. Radiation-induced lung injury (RILI). Front. Oncol. 2019; 9: 877. DOI: 10.3389/fonc.2019.00877.

Benveniste M.F., Gomez D., Carter B.W. et al. Recognizing radiation therapy-related complications in the chest. Radiographics. 2019; 39 (2): 344–366. DOI: 10.1148/rg.2019180061.

Linam J.M., Madtes D., Chow L. et al. The relationship between pulmonary function metrics and radiation-induced lung injury. J. Solid Tumors. 2012; 3 (1): 6–13. DOI: 10.5430/jst.v3n1p6.

Torre-Bouscoulet L., Muñoz-Montaño W.R., Martínez-Briseño 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. DOI: 10.1186/s12931-018-0775-2.

Yuan S.T., Frey K.A., Gross M.D. et al. Changes in global function and regional ventilation and perfusion on SPECT during the course of radiotherapy in patients with non-small-cell lung cancer. Int. J. Radiat. Oncol. Biol. Phys. 2012; 82 (4): e631–638. DOI: 10.1016/j.ijrobp.2011.07.044.

Rawat S., Kumar G., Puri A. et al. Correlation of six-minute walk test, pulmonary function test and radiation pneumonitis in the management of carcinoma of oesophagus: a prospective pilot study. J. Radiother. Pract. 2011; 10 (3): 191–199. DOI: 10.1017/S146039691000035X.

Torre-Bouscoulet L., Arroyo-Hernández M., Martínez-Briseño D. et al. Longitudinal evaluation of lung function in patients with advanced non-small cell lung cancer treated with concurrent chemoradiation therapy. Int. J. Radiat. Oncol. Biol. Phys. 2018; 101 (4): 910–918. DOI: 10.1016/j.ijrobp.2018.04.014.

Claude L., Pérol D., Ginestet C. et al. A prospective study on radiation pneumonitis following conformal radiation therapy in non-small-cell lung cancer: clinical and dosimetric factors analysis. Radiother. Oncol. 2004; 71 (2): 175–181. DOI: 10.1016/j.radonc.2004.02.005.

Wang J., Cao J., Yuan S. et al. Poor baseline pulmonary function may not increase the risk of radiation-induced lung toxicity. Int. J. Radiat. Oncol. Biol. Phys. 2013; 85 (3): 798–804. DOI: 10.1016/j.ijrobp.2012.06.040.

Tsoyi K., Chu S.G., Patino-Jaramillo N.G. et al. Syndecan-2 attenuates radiation-induced pulmonary fibrosis and inhibits fibroblast activation by regulating PI3K/Akt/ROCK pathway via CD148. Am. J. Respir. Cell Mol. Biol. 2018; 58 (2): 208–215. DOI: 10.1165/rcmb.2017-0088OC.

Woods A. Syndecans: transmembrane modulators of adhesion and matrix assembly. J. Clin. Invest. 2001; 107 (8): 935–941. DOI: 10.1172/FJCI12802.

Garcia A.N., Casanova N.G., Kempf C.L. et al. eNAMPT is a novel damage-associated molecular pattern protein that contributes to the severity of radiation-induced lung fibrosis. Am. J. Respir. Cell Molecul. Biol. 2022; 66 (5): 497–509. DOI: 10.1165/RCMB.2021-0357OC.

Zhao W., Wang L., Wang Y. et al. Injured endothelial cell: a risk factor for pulmonary fibrosis. Int. J. Mol. Sci. 2023; 24 (10): 8749. DOI: 10.3390/ijms24108749.

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