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Kokyu to Junkan Volume 60, Issue 12 （December 2012）

呼吸と循環 60巻12号（2012年12月発行）

Japanese English

症例

乳房温存療法に伴う放射線治療後に発症した器質化肺炎の2例 Two Cases of Organizing Pneumonia after Radiation Therapy for Breast Cancer 古瀬領人 ¹ , 黄英文 ¹ , 浅田佑介 ¹ , 須藤晃彦 ¹ , 高橋秀徳 ¹ , 上石修史 ¹ , 千代谷厚 ¹ , 木村吉成 ² , 田島敦志 ² , 古川潤二 ³ , 木村徳宏 ⁴ Erito Furuse ¹ , Hidefumi Koh ¹ , Yusuke Asada ¹ , Akihiko Sudoh ¹ , Hidenori Takahashi ¹ , Nobufumi Kamiishi ¹ , Atsushi Chiyotani ¹ , Yoshishige Kimura ² , Atsushi Tajima ² , Junji Furukawa ³ , Tokuhiro Kimura ⁴ ¹済生会宇都宮病院呼吸器内科 ²済生会宇都宮病院呼吸器外科 ³済生会宇都宮病院外科 ⁴慶應義塾大学医学部病理学教室 ¹Division of Pulmonary Medicine, Department of Internal Medicine, Saiseikai Utsunomiya Hospital ²Department of General Thoracic Surgery, Saiseikai Utsunomiya Hospital ³Department of Surgery, Saiseikai Utsunomiya Hospital ⁴Department of Pathology, Keio University School of Medicine キーワード：器質化肺炎 , 乳癌 , 放射線療法 , organizing pneumonia , breast cancer , radiation therapy Keyword: 器質化肺炎 , 乳癌 , 放射線療法 , organizing pneumonia , breast cancer , radiation therapy pp.1295-1299

発行日 2012年12月15日 Published Date 2012/12/15

DOI https://doi.org/10.11477/mf.1404102118

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要旨　乳房温存療法は臨床病期0，ⅠおよびⅡ期のうち腫瘍が3cm以下の乳癌患者に対する標準治療であるが，合併症として放射線肺臓炎，薬剤性肺炎，器質化肺炎に注意を要する．提示した2症例はともに放射線照射後4～8カ月後，照射野に一致しない浸潤影を認め，精査の結果，放射線照射後の器質化肺炎と診断された．本症の発症頻度は1.3～2.4%と報告されているが，正確な頻度は不明である．当院では2004～2011年の間に乳癌患者887例中537例(60.5%)に乳房温存療法が行われ，3例が本症を発症していた．ただし放射線照射例の約70%にホルモン療法が併用されており，薬剤の影響や自然軽快例については明らかではない．乳房温存療法を受ける症例は今後も増加することが予測され，本症を念頭に置いた経過観察が重要である．

　Although breast-conserving therapy(BCT)has recently become the standard care for early stage breast cancer, radiation pneumonitis, drug-induced pneumonitis and the organizing of pneumonia are important adverse effects. We report two patients that presented cough and fever for 4 to 8 months after the completion of tangential irradiation for breast cancer. Chest radiograph and computed tomography demonstrated consolidation outside the irradiated area. Radiation-related organizing pneumonia was diagnosed from its clinical course, laboratory and histological findings. It has been reported that the incidence of organizing pneumonia was 1.3 to 2.4% in previous reports, but there seems to be no established data. In our hospital, 537 patients have undergone BCT from January, 2004 to December, 2011. The incidence of organizing pneumonia was 3 patients(0.56%;3/537). One possibility is to assume that previous studies might have included drug-induced pneumonitis due to endocrine therapy or chemotherapy. Another possibility is that the radiation field tends to reduce in comparison with the past. It is essential to find out the pulmonary complications such as radiation-related organizing pneumonia after BCT.