Yasunori Enomoto1, Naoki Inui2, Terufumi Kato3, Tomohisa Baba3, Masato Karayama4, Yutaro Nakamura5, Takashi Ogura3, Takafumi Suda5. 1. Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan. Electronic address: enomotoy@hama-med.ac.jp. 2. Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan; Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Japan. 3. Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan. 4. Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan; Department of Clinical Oncology, Hamamatsu University School of Medicine, Japan. 5. Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
Abstract
OBJECTIVES: Although acute exacerbation of pre-existing interstitial lung disease (AE-ILD) associated with cytotoxic chemotherapy has been recognized as a severe complication in lung cancer treatment, its risk factors have not been fully studied. MATERIALS AND METHODS: Among lung cancer patients receiving cytotoxic chemotherapy, patients with pre-existing ILD were identified based on the pretreatment high-resolution computed tomography (HRCT) findings. Chemotherapy-associated AE-ILD was defined as deterioration or development of dyspnea and HRCT findings of new bilateral ground-glass attenuations with/without non-segmental consolidation superimposed on pre-existing interstitial shadows, without evidence of pulmonary infection, congestion, or pulmonary embolism, within four weeks after the last administration of chemotherapy. Baseline characteristics were reviewed and the risk factors for chemotherapy-associated AE-ILD were evaluated by logistic regression analyses. RESULTS: Among 85 patients identified as having pre-existing ILD, chemotherapy-associated AE-ILD occurred in 26 patients (30.6%); 8 patients died and 11 patients had a severely deteriorated general condition despite intensive treatment. Compared with those without AE-ILD, patients with AE-ILD had significantly lower forced vital capacity (FVC) (median: 91.1% versus 76.6%, P=0.01). Univariate and multivariate logistic regression analyses identified baseline lower FVC and non-small cell lung cancer (NSCLC) as the risk factors for this severe event (odds ratio of FVC: 0.97, 95% confidence interval: 0.94-0.99; odds ratio of NSCLC: 4.65, 95% confidence interval: 1.10-19.76). CONCLUSION: Chemotherapy-associated AE-ILD was a frequent and lethal complication in lung cancer treatment for patients with pre-existing ILD. Spirometric assessment of pulmonary function may be useful to predict the event.
OBJECTIVES: Although acute exacerbation of pre-existing interstitial lung disease (AE-ILD) associated with cytotoxic chemotherapy has been recognized as a severe complication in lung cancer treatment, its risk factors have not been fully studied. MATERIALS AND METHODS: Among lung cancerpatients receiving cytotoxic chemotherapy, patients with pre-existing ILD were identified based on the pretreatment high-resolution computed tomography (HRCT) findings. Chemotherapy-associated AE-ILD was defined as deterioration or development of dyspnea and HRCT findings of new bilateral ground-glass attenuations with/without non-segmental consolidation superimposed on pre-existing interstitial shadows, without evidence of pulmonary infection, congestion, or pulmonary embolism, within four weeks after the last administration of chemotherapy. Baseline characteristics were reviewed and the risk factors for chemotherapy-associated AE-ILD were evaluated by logistic regression analyses. RESULTS: Among 85 patients identified as having pre-existing ILD, chemotherapy-associated AE-ILD occurred in 26 patients (30.6%); 8 patients died and 11 patients had a severely deteriorated general condition despite intensive treatment. Compared with those without AE-ILD, patients with AE-ILD had significantly lower forced vital capacity (FVC) (median: 91.1% versus 76.6%, P=0.01). Univariate and multivariate logistic regression analyses identified baseline lower FVC and non-small cell lung cancer (NSCLC) as the risk factors for this severe event (odds ratio of FVC: 0.97, 95% confidence interval: 0.94-0.99; odds ratio of NSCLC: 4.65, 95% confidence interval: 1.10-19.76). CONCLUSION: Chemotherapy-associated AE-ILD was a frequent and lethal complication in lung cancer treatment for patients with pre-existing ILD. Spirometric assessment of pulmonary function may be useful to predict the event.