Chemotherapy-induced pulmonary complications in cancer: Significance of clinicoradiological correlation

Abstract

Chemotherapy while revolutionizing cancer management by improving survival and quality of life; is also associated with several adverse effects. Lung is the most common organ affected in chemotherapy-related complications, due to either drug toxicity or more commonly due to infections caused by immunosuppression and less commonly due to immune-mediated injury. Radiology, when used in combination with clinical and lab data, can help reach the specific diagnosis or narrow down the differentials. The common radiological patterns of drug toxicity include pulmonary interstitial and airway infiltrates, diffuse alveolar damage, nonspecific interstitial pneumonia, eosinophilic pneumonia, cryptogenic organizing pneumonia, pulmonary hemorrhage, edema and hypertension. Cancer patients are immunosuppressed due to the underlying malignancy itself or due to therapy and are prone to a gamut of opportunistic infections including viral, bacterial, fungal and mycobacterial pathogens. Immune reconstitution inflammatory syndrome (IRIS), a well-known complication in HIV, is now being increasingly recognized in non-HIV patients with immunosuppression. Engraftment syndrome is specifically seen following hematopoietic stem cell transplant during neutrophil recovery phase. Pulmonary involvement is frequent, causing a radiological picture of noncardiogenic pulmonary edema. Thus, radiology in combination with clinical background and lab parameters helps in detecting and differentiating various causes of pulmonary complications. This approach can help alter potentially toxic treatment and initiate early treatment depending on the diagnosis.

Rising cases of drug‐induced pulmonary fibrosis: Analysis of the Food and Drug Administration Adverse Event Reporting System (FAERS) database, 2000–2022

“…4 It is theorized that PF may occur due to deposition of collagen in the lungs after cellular damage and from direct injury to the lung tissue leading to increased elastin production. 17 The lungs are inherently the most likely organs to be affected by antineoplastic agents, which may be due to the mechanisms listed above, or alternatively may be related to immunosuppressive infections. 17 Of the top 10 most reported drugs, only amiodarone was not associated with an increase in reports over time.…”

“…17 The lungs are inherently the most likely organs to be affected by antineoplastic agents, which may be due to the mechanisms listed above, or alternatively may be related to immunosuppressive infections. 17 Of the top 10 most reported drugs, only amiodarone was not associated with an increase in reports over time. This finding may be due in part to longstanding vigilance on the part of prescribers regarding potential pulmonary toxicity secondary to amiodarone based on guidelines for regularly screening patients for pulmonary toxicity.…”

“…Antineoplastics, such as bleomycin, disrupt cell replication and/or damage DNA 4 . It is theorized that PF may occur due to deposition of collagen in the lungs after cellular damage and from direct injury to the lung tissue leading to increased elastin production 17 . The lungs are inherently the most likely organs to be affected by antineoplastic agents, which may be due to the mechanisms listed above, or alternatively may be related to immunosuppressive infections 17 …”

Bioactive Polymeric Nanoparticles of Moringa oleifera Induced Phyto-Photothermal Sensitization for the Enhanced Therapy of Retinoblastoma

“…Despite significant improvement in the field of drug discovery and development for cancer treatment, a major concern always arises regarding the adverse side effects and toxicity that is caused by these chemo drugs or radiation-based effects. The most used chemotherapeutic drugs such as 5-Fluorouracil, Doxorubicin, and Cyclophosphamide has been reported for their cardio, renal, bladder, and pulmonary toxicities [ 33 , 34 , 35 , 36 , 37 ]. This leads to a quest for naturally occurring substances as novel formulations against the fatal disease.…”

Diminazene aceturate‐induced cytotoxicity is associated with the deregulation of cell cycle signaling and downregulation of oncogenes Furin, c‐MYC, and FOXM1 in human cervical carcinoma Hela cells

“…[2][3][4][5][6] While some drugs have resulted in excellent prognosis in some instances, such as an 80% survival rate in Hodgkin's lymphoma when used in combination, [7] most are associated with severe side effects such as lung, heart, and renal toxicities and development of secondary cancers. [8][9][10][11] In general, the cytotoxic agents show a low therapeutic index, and their side effects are generally consequences of nonspecific drug exposure to off-target tissues. [12] Moreover, as a first-line treatment, cytotoxic agents often produce therapy resistance, making the second-line treatment option more challenging.…”