Bilateral Pleural Effusion due to Mediastinal Fibrosis Induced by Radiotherapy

Morrone, Nelson; Volpe, Veronica; Dourado, Ada Maria; Mitre, Fuad; Coletta, Ester Nei Aparecida Martins

doi:10.1378/chest.104.4.1276

Cited by 40 publications

(34 citation statements)

References 7 publications

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“…Irradiation was delivered with a total dose of 60 Gy for a lung squamous cell carcinoma with lymph node involvement, and with 40 Gy for a Hodgkin's disease. Similar observations were carried out on one single case of irradiated Hodgkin's disease both by RODRIGUEZ GARCIA et al [3] (with a radiation dose of 40 Gy) and by MORRONE et al [4]. Bronchial stenosis, as seen in the present patient, was not rep-orted in these series.…”

Section: Discussionsupporting

confidence: 88%

Bronchial stenosis and sclerosing mediastinitis: an uncommon complication of external thoracic radiotherapy

Dechambre

Dorzee

et al. 1998

Eur Respir J

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aaThoracic radiotherapy is one of the major treatment modalities in lung cancer. Radiation pneumonitis and fibrosis are well-known side-effects. ''Radiation bronchitis" in the form of inflammatory reaction of the airways mucosa following therapeutic external-beam radiation and highdose endobronchial radiation (brachytherapy) has also been reported. Otherwise, there is very little mention in the literature regarding the effects of the radiation on the airways.In this article, we report a case of sclerosing mediastinitis with bronchial stenosis discovered 1 yr after external thoracic radiotherapy. Case reportA right upper lobectomy for a peripheral adenocarcinoma of the ventral segment of the right upper lobe was performed on a 59 yr old woman in November 1992. This patient had a relevant medical history of a 40 pack-year history of smoking, a left sylvian stroke in 1988, and an inferior myocardial infarction in 1990. The postoperative staging (tumour, node, metastasis (TNM) classification), using a systematic mediastinal sampling, was T3N0M0 in view of an extension to the parietal pleura and the absence of metastases.External radiation therapy was, therefore, performed using an 18 MeV photon linear accelerator. Doses of 2 Gray (Gy) each were delivered in 27 fractions by a combination of anteroposterior parallel opposed fields (16 fractions), anterior direct fields (seven fractions), and anteroposterior opposed oblique angle wedge fields (four fractions). The total dose applied to the tumour bed and the right hilum was around 57 Gy. The total dose applied to the paratracheal left chain was approximately 45 Gy, and the spinal cord received about 42 Gy.In November 1993, the patient complained of persistent cough and a gradual onset of dyspnoea. On physical examination, a decrease in the breath sounds over the right lung was noted, the left lung being clear; no other findings of note were detected. Blood results were normal except for a slight elevation of hepatic enzymes. The carcinoembryonic antigen (CEA) was 10 ng·mL -1 (normal values <7 ng·mL -1 ), the level before the operation being 15 ng·mL -1 . The Mantoux test was negative.Chest radiography disclosed a right hilar enlargement and a right apical thickening. Thoracic computed tomography (CT) showed the presence of a right paratracheal mass with extension around the right main-stem bronchus, the lumen of which was severely narrowed ( fig. 1). The subcarinal area was also involved. A slight heterogeneous enhancement was observed after administration of contrast material. An area of soft tissue density containing dilated bronchi, with a straight edge corresponding to radiation fibrosis localized in the middle lobe with adjacent pleural thickening was present conforming to the radiation port. Magnetic resonance imaging (MRI) revealed that this mass had a low intensity signal both in T1 and T2 weighted images. This short T2 relaxation time was said to be suggestive of a benign fibrous process.Fibreoptic examination revealed an 80% extrinsic stenosis of the right ma...

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Section: Discussionsupporting

confidence: 88%

Bronchial stenosis and sclerosing mediastinitis: an uncommon complication of external thoracic radiotherapy

Dechambre

Dorzee

et al. 1998

Eur Respir J

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“…[11][12][13][14][15] However, data concerning postirradiation pleural effusions are limited to case reports of Hodgkin's disease. 5,6,10 There are also only a few reports on pericarditis and myocardial infarction associated with irradiation. [7][8][9] Conventional radiotherapy for esophageal cancer is usually indicated for advanced cancer.…”

Section: Discussionmentioning

confidence: 99%

Death Related to Pleural and Pericardial Effusions Following Chemoradiotherapy in a Patient with Advanced Cancers of the Esophagus and Stomach

et al. 2007

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Abstract. Chemoradiotherapy improves therapeutic outcome in many different types of cancer. However, there is concern about the occurrence of delayed complications, as patients are surviving longer. Because patients with esophageal cancer receive a wide range of irradiation field to the mediastinum and the heart, they may have delayed complications of heart and lung functions as previously reported in Hodgkin's disease. We presented a case of death related to uncontrollable pleural and pericardial effusions in a patient with advanced cancers of the esophagus and stomach who achieved a complete remission following chemoradiotherapy and salvage gastric resection, focusing on detailed pathophysiological conditions related to concurrent chemoradiotherapy. (Keio J Med 56 (4) : 124 -129, December 2007)

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“…The occasional literature that does report radiation-induced pleural effusions in humans points to impaired lymphatic drainage of the pleural space. [117][118][119] The possibility that this may be the culprit in generating effusions in mice is supported by the recent observation in the female C57BL/6 strain of a decline in the density of lymphatic vessels of subpleural and interstitial lymphatics following WTI. 120 Finally, there is a clear impression from rhesus macaques that pleural effusions accompany radiation lung injury after high doses of WTI.…”

Section: Weeks After Irradiationmentioning

confidence: 93%

A survey of changing trends in modelling radiation lung injury in mice: bringing out the good, the bad, and the uncertain

Dabjan

Buck

Jackson

et al. 2016

Laboratory Investigation

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Within this millennium there has been resurgence in funding and research dealing with animal models of radiationinduced lung injury to identify and establish predictive biomarkers and effective mitigating agents that are applicable to humans. Most have been performed on mice but there needs to be assurance that the emphasis on such models is not misplaced. We therefore considered it timely to perform a comprehensive appraisal of the literature dealing with radiation lung injury of mice and to critically evaluate the validity and clinical relevance of the research. A total of 357 research papers covering the period of 1970-2015 were extensively reviewed. Whole thorax irradiation (WTI) has become the most common treatment for studying lung injury in mice and distinct trends were seen with regard to the murine strain, radiation dose, intended pathology investigated, length of study, and assays. Recently, the C57BL/6 strain has been increasingly used in the majority of these studies with the notion that they are susceptible to pulmonary fibrosis. Nonetheless, many of these investigations depend on animal survival as the primary end point and neglect the importance of radiation pneumonitis and the anomaly of lethal pleural effusions. A relatively large variation in survival times of C5BL/6 mice is also seen among different institutions pointing to the need for standardization of radiation treatments and environmental conditions. An analysis of mitigating drug treatments is complicated by the fact that the majority of studies are limited to the C57BL/6 strain with a premature termination of the experiments and do not establish whether the treatment actually prevents or simply delays the progression of radiation injury. This survey of the literature has pointed to several improvements that need to be considered in establishing a reliable preclinical murine model of radiation lung injury. The lethality end point should also be used cautiously and with greater emphasis on other assays such as non-invasive lung functional and imaging monitoring in order to quantify specific pulmonary injury that can be better extrapolated to radiation toxicity encountered in our own species.Laboratory Investigation (2016) 96, 936-949;

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Bilateral Pleural Effusion due to Mediastinal Fibrosis Induced by Radiotherapy

Cited by 40 publications

References 7 publications

Bronchial stenosis and sclerosing mediastinitis: an uncommon complication of external thoracic radiotherapy

Bronchial stenosis and sclerosing mediastinitis: an uncommon complication of external thoracic radiotherapy

Death Related to Pleural and Pericardial Effusions Following Chemoradiotherapy in a Patient with Advanced Cancers of the Esophagus and Stomach

A survey of changing trends in modelling radiation lung injury in mice: bringing out the good, the bad, and the uncertain

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