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DOI: https://doi.org/10.4046/trd.2020.0135    [Accepted]
Published online February 10, 2021.
The Effect of Simultaneous Pulmonary Rehabilitation during Thoracic Radiotherapy for Malignant Diseases
Myeong Geun Choi, 1, Hyang Yi Lee, 1, Si Yeol Song, 2, Su Ssan Kim, 2, Seung Hak Lee, 3, Won Kim, 3, Chang-Min Choi, 1,4, Sei Won Lee, 1
1Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
2Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
3Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
4Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Correspondence:  Sei Won Lee, Tel: 82-2-3010-3990, Fax: 82-2-3010-3990, 
Email: iseiwon@gmail.com
Received: 8 November 2020   • Revised: 1 January 2021   • Accepted: 10 February 2021
Abstract
Introduction
Radiotherapy is a treatment option for lung or esophageal cancer, especially when surgery is not possible due to poor lung function. However, radiotherapy can affect pulmonary function and 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). Materials and methods Patients who had undergone radiotherapy for thoracic malignant disease for between January 2018 and June 2019 were retrospectively analyzed in this matched case control study. Results from pulmonary function test and 6-minute walking test (6MWT) conducted within six months before and after radiotherapy were analyzed.
Results
In total, 144 patients were analyzed, of whom 11 performed simultaneous PR with radiotherapy. From 133 patients in the control group, 33 were matched with 11 patients in the PR group. Changes in FEV1 and FEV1/FVC were significantly different between the PR group and the matched control group (+240mL vs. −10mL, P=0.017 and +5.5% vs. +1.0%, P=0.038, respectively). Median distance of 6MWT in the PR group also increased significantly from 407.5m to 493.0m after radiotherapy (P=0.017).
Conclusions
Simultaneous PR improved pulmonary function, especially FEV1, and exercise capacity in patients with lung or esophageal cancer even after radiotherapy. This may provide an important basis for further large population studies with long-term follow-up to identify effects of PR during thoracic radiotherapy.
Key Words: pulmonary rehabilitation, radiotherapy, pulmonary function test


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