Paulien G Westhoff1, Dirk K M De Ruysscher2, Franz M N H Schramel3, Metin Bulbul4, Amelie Dendooven5, Sherif Y El Sharouni6. 1. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands p.g.westhoff@umcutrecht.nl. 2. Department of Radiation Oncology, University Hospitals Leuven/KU Leuven, Leuven, Belgium. 3. Department of Pulmonary Diseases, Saint Antonius Hospital, Nieuwegein, The Netherlands. 4. Department of Pulmonary Diseases, University Medical Center Utrecht, Utrecht, The Netherlands. 5. Department of Pulmonary Diseases, University Medical Center Utrecht, Utrecht, The Netherlands Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands. 6. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
Abstract
BACKGROUND: After thoracic radiotherapy a pneumonitis may occur, mostly confined to the irradiated volume of the lung. In general, it resolves spontaneously without long-term effects. CASE REPORT: A 68-year-old man was diagnosed with a stage IIIA adenocarcinoma of the lung and was treated with sequential chemoradiation. He had a heart and kidney transplant for which an immunosuppressant was taken. During the fourth week of radiotherapy, he developed a bilateral interstitial pneumonia. Despite antibiotics and steroids, the patient died twelve days after the onset of complaints due to respiratory failure. Autopsy showed in all pulmonary lobes extensive diffuse alveolar damage, probably leading to respiratory insufficiency and death. Literature and Conclusion: Bilateral pneumonitis after radiotherapy is thought to be an immunologically-mediated response, which usually resolves without long-term effects. Since in radiation pneumonitis an increase in T-cells is described, the suppression of these cells by an immunosuppressant might have exaggerated the pulmonary toxicity. Copyright
BACKGROUND: After thoracic radiotherapy a pneumonitis may occur, mostly confined to the irradiated volume of the lung. In general, it resolves spontaneously without long-term effects. CASE REPORT: A 68-year-old man was diagnosed with a stage IIIA adenocarcinoma of the lung and was treated with sequential chemoradiation. He had a heart and kidney transplant for which an immunosuppressant was taken. During the fourth week of radiotherapy, he developed a bilateral interstitial pneumonia. Despite antibiotics and steroids, the patient died twelve days after the onset of complaints due to respiratory failure. Autopsy showed in all pulmonary lobes extensive diffuse alveolar damage, probably leading to respiratory insufficiency and death. Literature and Conclusion:Bilateral pneumonitis after radiotherapy is thought to be an immunologically-mediated response, which usually resolves without long-term effects. Since in radiation pneumonitis an increase in T-cells is described, the suppression of these cells by an immunosuppressant might have exaggerated the pulmonary toxicity. Copyright