Aims

Lung cancer is the leading cause of cancer death. Radiotherapy given in the curative setting is associated with a 3% risk of death from Pneumocystis jirovecii pneumonia (PJP). Prolonged courses of high-dose steroids also increase the risk of PJP. International guidelines recommend the use of chemoprophylaxis with trimethoprim-sulfamethoxazole for patients at high risk. We assessed the effect of an intervention designed to reduce the impact of PJP.

Materials and methods

Prophylaxis guidelines were introduced in 2016. Case records of patients treated with radical radiotherapy were examined for the periods 2014 to 2015 (pre-intervention) and 2017 to 2018 (post-intervention). In total, 247 patients were treated pre-intervention and 334 post-intervention.

Results

Freedom from PJP death at 1 year was 96% before intervention and 99% after (hazard ratio 0.3, 95% confidence interval 0.1–0.9, P = 0.029). Although the rate of use of chemoprophylaxis according to the guideline rose from 1% to 13% (P = 0.003), the use of high-dose steroids also fell from 35% to 16% (P < 0.00001).

Conclusions

Reducing radiotherapy-associated infections is an important component of radical treatment in lung cancer. Highlighting chemoprophylaxis guidelines reduced the death rate from PJP, with an associated more judicious use of steroids. Advocating prophylaxis in patients with lymphocyte count <0.6 × 109/l is the next intervention to be studied.

中文翻译：

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降低肺部根治性放射治疗后吉氏肺囊虫肺炎的死亡风险

宗旨

肺癌是癌症死亡的主要原因。根治性放疗与 3% 的耶氏肺孢子菌肺炎 (PJP)死亡风险相关。长时间使用大剂量类固醇也会增加 PJP 的风险。国际指南推荐对高危患者使用甲氧苄啶-磺胺甲恶唑进行化学预防。我们评估了旨在减少 PJP 影响的干预措施的效果。

材料和方法

2016 年引入了预防指南。检查了 2014 年至 2015 年（干预前）和 2017 年至 2018 年（干预后）期间接受根治性放疗的患者的病例记录。总共有 247 名患者在干预前接受治疗，334 名患者在干预后接受治疗。

结果

干预前 1 年无 PJP 死亡率为 96%，干预后为 99%（风险比 0.3，95% 置信区间 0.1-0.9，P = 0.029）。虽然根据指南化学预防的使用率从 1% 上升到 13% ( P = 0.003)，但大剂量类固醇的使用率也从 35% 下降到 16% ( P < 0.00001)。

结论

减少放疗相关感染是肺癌根治性治疗的重要组成部分。强调化学预防指南降低了 PJP 的死亡率，同时更明智地使用类固醇。提倡对淋巴细胞计数 <0.6 × 109/l 的患者进行预防是下一个要研究的干预措施。