Stéphane Jouneau1, Elodie Vauléon2, Sylvie Caulet-Maugendre3, Elisabeth Polard4, Anne-Claire Volatron5, Catherine Meunier6, Pierre Tattevin7, David Montani8, Etienne Garin9, Jean-Luc Raoul2, Philippe Delaval10. 1. Respiratory Diseases Department, Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University, Rennes, France. Electronic address: Stephane.jouneau@chu-rennes.fr. 2. Medical Oncology Department, Centre Eugène Marquis, European University in Brittany, Rennes, France. 3. Histopathology Department, Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University, Rennes, France. 4. Clinical Pharmacology Department, Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University, Rennes, France. 5. Intensive Care Department, Pau Hospital, Pau, France. 6. Pharmacovigilance, Radiology Department, Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University, Rennes, France. 7. Infectious Diseases and Intensive Care Department, Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University, Rennes, France. 8. Respiratory Diseases Department, INSERM U999, Paris-Sud 11 University, Centre National de Référence de l'Hypertension Pulmonaire Sévère, Hôpital Antoine-Béclère, Assistance Publique-Hôpitaux de Paris, Clamart, France. 9. Nuclear Medicine Department, Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University, Rennes, France. 10. Respiratory Diseases Department, Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University, Rennes, France.
Abstract
BACKGROUND: The drug (131)I-labeled lipiodol is used as internal radiotherapy for unresectable hepatocellular carcinoma. Although the drug was considered safe during preapproval studies, we observed several cases of interstitial pneumonia following its administration. METHODS: Cases were retrospectively identified through the drug safety unit database of Rennes University Hospital. RESULTS: From 1994 to 2009, interstitial pneumonia developed in 15 patients following (131)I-labeled lipiodol administration, with an estimated prevalence of 15.5 cases (95% CI, 7.7-23.2) per 1,000 treated patients. Mean age of the patients was 60 ± 8 years, and the male to female ratio was 6.5:1. All patients had cirrhosis, mainly related to long-term alcohol intoxication (n = 12). Most (n = 10) cases occurred after the second (131)I-labeled lipiodol injection. The median delay between last (131)I-labeled lipiodol administration and first respiratory symptoms was 30 days (interquartile range, 16.5-45 days). All patients presented with shortness of breath. Physical examination mostly revealed fever (n = 11) and bilateral crackles (n = 12). Chest CT scan showed bilateral ground-glass opacities (n = 8) with septal thickening, retraction, or both (n = 8). BAL (n = 7) was remarkable for increased neutrophils (n = 4) or CD8(+) T cell count (n = 3). Despite corticosteroids, 12 (80%) patients died, mostly of untractable respiratory failure (n = 9). Median delay between last (131)I-labeled lipiodol injection and death was 63 days (interquartile range, 34-129 days). CONCLUSIONS: Interstitial pneumonia may be a serious and not uncommon complication of (131)I-labeled lipiodol administration.
BACKGROUND: The drug (131)I-labeled lipiodol is used as internal radiotherapy for unresectable hepatocellular carcinoma. Although the drug was considered safe during preapproval studies, we observed several cases of interstitial pneumonia following its administration. METHODS: Cases were retrospectively identified through the drug safety unit database of Rennes University Hospital. RESULTS: From 1994 to 2009, interstitial pneumonia developed in 15 patients following (131)I-labeled lipiodol administration, with an estimated prevalence of 15.5 cases (95% CI, 7.7-23.2) per 1,000 treated patients. Mean age of the patients was 60 ± 8 years, and the male to female ratio was 6.5:1. All patients had cirrhosis, mainly related to long-term alcohol intoxication (n = 12). Most (n = 10) cases occurred after the second (131)I-labeled lipiodol injection. The median delay between last (131)I-labeled lipiodol administration and first respiratory symptoms was 30 days (interquartile range, 16.5-45 days). All patients presented with shortness of breath. Physical examination mostly revealed fever (n = 11) and bilateral crackles (n = 12). Chest CT scan showed bilateral ground-glass opacities (n = 8) with septal thickening, retraction, or both (n = 8). BAL (n = 7) was remarkable for increased neutrophils (n = 4) or CD8(+) T cell count (n = 3). Despite corticosteroids, 12 (80%) patients died, mostly of untractable respiratory failure (n = 9). Median delay between last (131)I-labeled lipiodol injection and death was 63 days (interquartile range, 34-129 days). CONCLUSIONS:Interstitial pneumonia may be a serious and not uncommon complication of (131)I-labeled lipiodol administration.
Authors: Tushar Garg; Apurva Shrigiriwar; Peiman Habibollahi; Mircea Cristescu; Robert P Liddell; Julius Chapiro; Peter Inglis; Juan C Camacho; Nariman Nezami Journal: Cancers (Basel) Date: 2022-07-10 Impact factor: 6.575