바로가기메뉴

본문 바로가기 주메뉴 바로가기

Tuberculosis & Respiratory Diseases

Article Contents

Prev Next
e-Submission

Vol.84 No.2
Citation Share

The Effects of Simultaneous Pulmonary Rehabilitation during Thoracic Radiotherapy in the Treatment of Malignant Diseases

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2021, v.84 no.2, pp.148-158
https://doi.org/10.4046/trd.2020.0135
Choi Myeong Geun (Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea)
Lee Hyang Yi (University of Ulsan College of Medicine, Seoul, Republic of Korea)

Kim Su Ssan (Asan Medical Center, University of Ulsan College of Medicine)



(DepartmentPulmonary and Critical Care Medicine, Asan Medical Center)
Choi, M. G. , Lee, H. Y. , Kim, S. S. , & (2021). The Effects of Simultaneous Pulmonary Rehabilitation during Thoracic Radiotherapy in the Treatment of Malignant Diseases. Tuberculosis & Respiratory Diseases, 84(2), 148-158, https://doi.org/10.4046/trd.2020.0135
  • Downloaded
  • Viewed
PDF Download

Abstract

Background: Radiotherapy is a common treatment option for lung or esophageal cancer, particularly when surgery is not feasible for patients with poor lung function. However, radiotherapy can affect pulmonary function and thereby induce pneumonitis or pneumonia, which can be fatal in patients with respiratory impairment. The purpose of this study is to evaluate if reductions in pulmonary function after radiotherapy can be minimized through simultaneous pulmonary rehabilitation (PR). Methods: In this matched case control study, we retrospectively analyzed patients who had undergone radiotherapy for thoracic malignant disease between January 2018 and June 2019. We analyzed results from pulmonary function tests and 6-minute walking tests (6MWT) conducted within the six months before and after radiotherapy treatment. Results: In total, results from 144 patients were analyzed, with 11 of the patients receiving PR and radiotherapy simultaneously. Of the 133 patients in the control group, 33 were matched with 11 patients in the PR group. Changes in forced expiratory volume in one second (FEV1) and FEV1/forced vital capacity were significantly different between the PR group and the matched control group (240 mL vs. –10 mL, p=0.017 and 5.5% vs. 1.0%, p=0.038, respectively). The median distance of 6MWT in the PR group also increased significantly, from 407.5 m to 493.0 m after radiotherapy (p=0.017). Conclusion: Simultaneous PR improved pulmonary function, particularly in measures of FEV1, and exercise capacity for patients with lung or esophageal cancer even after radiotherapy treatment. These findings may provide an important base of knowledge for further large population studies with long-term follow-up analysis in the identification of the PR’s effects during thoracic radiotherapy.

keywords
Pulmonary Rehabilitation, Radiotherapy, Pulmonary Function Tests

Reference

1.

1. Rochester CL, Vogiatzis I, Holland AE, Lareau SC, Marciniuk DD, Puhan MA, et al. An Official American Thoracic Society/European Respiratory Society policy statement: enhancing implementation, use, and delivery of pulmonary rehabilitation. Am J Respir Crit Care Med 2015;192:1373-86.

2.

2. Troosters T, Casaburi R, Gosselink R, Decramer M. Pulmonary rehabilitation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005;172:19-38.

3.

3. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188:e13-64.

4.

4. de Torres JP, Marin JM, Casanova C, Cote C, Carrizo S, Cordoba-Lanus E, et al. Lung cancer in patients with chronic obstructive pulmonary disease: incidence and predicting factors. Am J Respir Crit Care Med 2011;184:913-9.

5.

5. Stigt JA, Uil SM, van Riesen SJ, Simons FJ, Denekamp M, Shahin GM, et al. A randomized controlled trial of postthoracotomy pulmonary rehabilitation in patients with resectable lung cancer. J Thorac Oncol 2013;8:214-21.

6.

6. Tarumi S, Yokomise H, Gotoh M, Kasai Y, Matsuura N, Chang SS, et al. Pulmonary rehabilitation during induction chemoradiotherapy for lung cancer improves pulmonary function. J Thorac Cardiovasc Surg 2015;149:569-73.

7.

7. Niezink AG, de Jong RA, Muijs CT, Langendijk JA, Widder J. Pulmonary function changes after radiotherapy for lung or esophageal cancer: a systematic review focusing on dosevolume parameters. Oncologist 2017;22:1257-64.

8.

8. Erven K, Weltens C, Nackaerts K, Fieuws S, Decramer M, Lievens Y. Changes in pulmonary function up to 10 years after locoregional breast irradiation. Int J Radiat Oncol Biol Phys 2012;82:701-7.

9.

9. Pinnix CC, Smith GL, Milgrom S, Osborne EM, Reddy JP, Akhtari M, et al. Predictors of radiation pneumonitis in patients receiving intensity modulated radiation therapy for Hodgkin and non-Hodgkin lymphoma. Int J Radiat Oncol Biol Phys 2015;92:175-82.

10.

10. Amercian Collge of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2013.

11.

11. Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of spirometry 2019update. An Official American Thoracic Society and European Respiratory Society technical statement. Am J Respir Crit Care Med 2019;200:e70-e88.

12.

12. Nagarajan K, Bennett A, Agostini P, Naidu B. Is preoperative physiotherapy/pulmonary rehabilitation beneficial in lung resection patients? Interact Cardiovasc Thorac Surg 2011;13:300-2.

13.

13. Cesario A, Ferri L, Galetta D, Cardaci V, Biscione G, Pasqua F, et al. Pre-operative pulmonary rehabilitation and surgery for lung cancer. Lung Cancer 2007;57:118-9.

14.

14. Bobbio A, Chetta A, Ampollini L, Primomo GL, Internullo E, Carbognani P, et al. Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. Eur J Cardiothorac Surg 2008;33:95-8.

15.

15. O’Meara P, Guenette JA, Raghavan N, Amornputtisathaporn N, Demetz CE, Nolan RL, et al. Mechanisms of dyspnoea relief following radiation treatment in a patient with severe COPD. Eur Respir J 2011;38:728-30.

16.

16. Yoshimi K, Ueki J, Seyama K, Takizawa M, Yamaguchi S, Kitahara E, et al. Pulmonary rehabilitation program including respiratory conditioning for chronic obstructive pulmonary disease (COPD): improved hyperinflation and expiratory flow during tidal breathing. J Thorac Dis 2012;4:259-64.

17.

17. Stav D, Raz M, Shpirer I. Three years of pulmonary rehabilitation: inhibit the decline in airflow obstruction, improves exercise endurance time, and body-mass index, in chronic obstructive pulmonary disease. BMC Pulm Med 2009;9:26.

18.

18. Embarak S, Mansour W, Mortada MA. Pulmonary rehabilitation slows the decline in forced expiratory volume in 1 second and improves body mass index in patients with chronic obstructive pulmonary disease. Egypt J Chest Dis Tuberc 2015;64:41-5.

19.

19. Cheng YJ, Macera CA, Addy CL, Sy FS, Wieland D, Blair SN. Effects of physical activity on exercise tests and respiratory function. Br J Sports Med 2003;37:521-8.

20.

20. Price DB, Roman-Rodriguez M, McQueen RB, BosnicAnticevich S, Carter V, Gruffydd-Jones K, et al. Inhaler errors in the CRITIKAL study: type, frequency, and association with asthma outcomes. J Allergy Clin Immunol Pract 2017;5:1071-81.

21.

21. Dudvarski Ilic A, Zugic V, Zvezdin B, Kopitovic I, Cekerevac I, Cupurdija V, et al. Influence of inhaler technique on asthma and COPD control: a multicenter experience. Int J Chron Obstruct Pulmon Dis 2016;11:2509-17.

22.

22. Lorx A, Czovek D, Gingl Z, Makan G, Radics B, Bartusek D, et al. Airway dynamics in COPD patients by within-breath impedance tracking: effects of continuous positive airway pressure. Eur Respir J 2017;49:1601270.

23.

23. Incorvaia C, Russo A, Foresi A, Berra D, Elia R, Passalacqua G, et al. Effects of pulmonary rehabilitation on lung function in chronic obstructive pulmonary disease: the FIRST study. Eur J Phys Rehabil Med 2014;50:419-26.

24.

24. Spruit MA, Pitta F, Garvey C, ZuWallack RL, Roberts CM, Collins EG, et al. Differences in content and organisational aspects of pulmonary rehabilitation programmes. Eur Respir J 2014;43:1326-37.

25.

25. Sahin H, Naz I. Why are COPD patients unable to complete the outpatient pulmonary rehabilitation program? Chron Respir Dis 2018;15:411-8.

26.

26. Mendes de Oliveira JC, Studart Leitao Filho FS, Malosa Sampaio LM, Negrinho de Oliveira AC, Hirata RP, Costa D, et al. Outpatient vs. home-based pulmonary rehabilitation in COPD: a randomized controlled trial. Multidiscip Respir Med 2010;5:401-8.

27.

27. Keating A, Lee A, Holland AE. What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review. Chron Respir Dis 2011;8:89-99.

28.

28. Quist M, Rorth M, Langer S, Jones LW, Laursen JH, Pappot H, et al. Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy: a pilot study. Lung Cancer 2012;75:203-8.

29.

29. Licker M, Karenovics W, Diaper J, Fresard I, Triponez F, Ellenberger C, et al. Short-term preoperative high-intensity interval training in patients awaiting lung cancer surgery: a randomized controlled trial. J Thorac Oncol 2017;12:323-33.

30.

30. Baldwin C, Spiro A, Ahern R, Emery PW. Oral nutritional interventions in malnourished patients with cancer: a systematic review and meta-analysis. J Natl Cancer Inst 2012;104:371-85.

31.

31. Granger CL. Physiotherapy management of lung cancer. J Physiother 2016;62:60-7.

32.

32. Marks LB, Bentzen SM, Deasy JO, Kong FM, Bradley JD, Vogelius IS, et al. Radiation dose-volume effects in the lung. Int J Radiat Oncol Biol Phys 2010;76(3 Suppl):S70-6.

33.

33. Manini TM, Everhart JE, Patel KV, Schoeller DA, Colbert LH, Visser M, et al. Daily activity energy expenditure and mortality among older adults. JAMA 2006;296:171-9.

34.

34. Jung KW, Won YJ, Kong HJ, Lee ES; Community of Population-Based Regional Cancer Registries. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2015. Cancer Res Treat 2018;50:303-16.

Tuberculosis & Respiratory Diseases

e-Submission OA Policy