폐암환자에서 방사선 폐렴 예측을 위한 혈장 Cytokine측정

Purpose :To investigate whether changes in plasma concentrations of transforming growth factor-$\beta$1(TGF-$\beta$1), tumor necrosis factor-alpha (TNF-$\alpha$) and interleukin-6 (IL-6) could be used to identify the development of radiation-induced pneumonitis in the lung cancer patients. Methods and Materials :Seventeen patients with lung cancer (11 NSCLC, 6 SCLC) were enrolled in a prospective study designed to evaluate clinical and molecular biologic correlation of radiation-induced pneumonitis. The study began in May 1998 and completed in July 1999. All patients were treated with radiotherapy with curative intent : 1.8 Gy per day, 5 fractions per week. Serial measurements of plasma TGF-$\beta$1, TNF-$\alpha$ and IL-6 were obtained in all patients before, weekly during radiotherapy and at each follow-up visits after completion of treatment. These measurements were quantified using enzyme linked immunosorbent assay (ELISA). All patients were evaluated for signs and symptoms of pneumonitis at each follow-up visit after completion of radiotherapy. High resolution CT (HRCT) scans were obtained when signs and symptoms of pneumonitis were developed after completion of radiotherapy. Results : Thirteen patients eventually developed signs and symptoms of clinical pneumonitis 씬file four patients did not. TGF-$\beta$ 1 levels were elevated in all 13 patients with pneumonitis, which showed characteristic pattern of elevation (38.45 ng/ml at pretreatment, 13.66 ng/ml during radiotherapy, then 60.63 ng/ml at 2-4 weeks after completion of radiotherapy). The levels of TNF- $\alpha$ and IL-6 were also elevated In the group of patients who developed pneumonitis but the pattern was not characteristic. Conclusions : Changes in plasma TGF$\beta$-1 levels before, during and after radiotherapy appears to be a useful means by which to identify patients at risk for the development of symptomatic pneumonitis. Other cytokines like TNF- $\alpha$ and IL-6 shows no meaningful changes in association with radiation pneumonitis. 목적 :폐암으로 확진되어 근치적 방사선 치료를 받은 환자에서 방사선페렴이 발생할 수 있는 위험군을 사전에 예측해 보고자 혈장내 TGF-$\beta$1, TNF-$\alpha$, IL-6의 농도를 측정하여 페렴 발생과의 상관관계를 분석하고자 하였다. 재료 및 방법 : 1998년 5월부터 1999년 7월까지 폐암으로 확진되어 근치적 방사선 치료를 받은 17명의 환자(비소세포암 11명, 소세포암 6명)을 대상으로 하였다. 방사선 치료는 주 5회 매일 1.8 Gy씩 실시하였고 비소세포암과 소세포암에서 각각 평균 60 Gy와 져 Gy를 조사하였다. 모든 환자에서 방사선치료 전, 방사선치료 중 주 1회, 치료 후 추적관찰로 내원시마다 혈액을 채취하여 혈장 TGF-$\beta$1, TNF-$\alpha$ 및 IL-6의 양을 ELISA법으로 측정하였다. 모든 환자에서 단순흉부촬영(치료중 주1회, 치료 후 추적관찰 시마다 촬영) 및 방