Chronic Eosinophilic Pneumonia in a Breast Cancer Patient Post-Radiation Therapy: A Case Report

Chaaban, Said; Salloum, Victor

doi:10.4187/respcare.02458

Cited by 5 publications

(2 citation statements)

References 18 publications

(43 reference statements)

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“…In the case of permanent respiratory symptoms the alterations can lead to RILD (radiation-induced lung disease) [ 4 ]. In some cases, severe tissue complications such as bronchiolitis obliterans organizing pneumonia (BOOP) [ 5 , 6 ] or chronic eosinophilic pneumonia can evolve [ 7 ]—even in the “nonirradiated” lung [ 8 ]. Pneumonitis normally occurs between 6 and 21 weeks [ 1 , 9 , 10 ] after radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Occurrence of pneumonitis following radiotherapy of breast cancer – A prospective study

et al. 2018

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Aimof this study is to determine the temporal resolution of therapy-induced pneumonitis, and to assess promoting factors in adjuvant treated patients with unilateral mammacarcinoma.Patients and methodsA total of 100 post-surgery patients were recruited. The cohort was treated by 2 field radiotherapy (2FRT; breast and chest wall, N = 75), 3 field radiotherapy (3FRT; + supraclavicular lymphatic region, N = 8), or with 4 field radiotherapy (4FRT; + parasternal lymphatic region, N = 17). Ninety-one patients received various systemic treatments prior to irradiation. Following an initial screening visit post-RT, two additional visits after 12 and 25 weeks were conducted including radiographic examination. In addition, general anamnesis and the co-medication were recorded. The endpoint was reached as soon as a pneumonitis was developed or at maximum of six months post-treatment.ResultsA pneumonitis incidence of 13% was determined. Of 91 patients with prior systemic therapy, 11 patients developed pneumonitis. Smoking history and chronic obstructive pulmonary disease (COPD) appeared to be positive predictors, whereas past pneumonia clearly promoted pneumonitis. Further pneumonitis-promoting predictors are represented by the applied field extensions (2 field radiotherapy [2FRT] < 3 field radiotherapy [3FRT] < 4 field radiotherapy [4FRT]) and the type of combined initial systemic therapies. As a consequence, all of the three patients in the study cohort treated with 4FRT and initial chemotherapy combined with anti-hormone and antibody protocols developed pneumonitis. A combination of the hormone antagonists tamoxifen and goserelin might enhance the risk for pneumonitis. Remarkably, none of the 11 patients co-medicated with statins suffered from pneumonitis.ConclusionsThe rapidly increasing use of novel systemic therapy schedules combined with radiotherapy (RT) needs more prospective studies with larger cohorts. Our results indicate that contribution to pneumonitis occurrence of various (neo)adjuvant therapy approaches followed by RT is of minor relevance, whereas mean total lung doses of >10 Gy escalate the risk of lung tissue complications. The validity of potential inhibitors of therapy-induced pneumonitis as observed for statin co-medication should further be investigated in future trials.

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Section: Introductionmentioning

confidence: 99%

Occurrence of pneumonitis following radiotherapy of breast cancer – A prospective study

et al. 2018

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“…[12,13] Cottin and Chaaban successively reported cases of patient with CEP in breast patients post-radiation therapy, and all patients rapidly improved with oral corticosteroids without sequelae. [13,14] In addition to radiotherapy, triggers, such as drugs, toxins, and environmental exposure, are usually needed. [13,15] No case of trastuzumab causing CEP has been reported, but there are reports of trastuzumab related to pulmonary interstitial disease in the NSABP B-31 and N9831 trials, which revealed that 9 patients in the trastuzumab group had interstitial pneumonitis.…”

Section: Discussionmentioning

confidence: 99%

Chronic eosinophilic pneumonia after trastuzumab and radiation therapy for breast cancer

Fan¹,

Wang

2019

Medicine

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Rationale:Chronic eosinophilic pneumonia (CEP) is rare and an idiopathic disorder. The disease has been associated with drugs, infection, or irradiation, and its relationship with asthma remains unclear.Patient concerns:We reported a case of a 49-year-old female patient after trastuzumab and radiation therapy for breast cancer. Two months after radiation treatment, the patient complained of productive cough, progressive breathlessness, occasional wheezing, and left pectoralgia.Diagnoses:Computed tomography (CT) scan revealed infiltrates in lungs. Without evidence of infection, marked increased eosinophils in a transbronchial biopsy performed from the left upper lobe confirmed the diagnosis of CEP after trastuzumab and radiation therapy.Interventions:The patient was started with oral prednisone at 0.5 mg/kg/day.Outcomes:A CT scan of the chest obtained 2 weeks after steroid treatment showed diminishment of the lesions, and at the 6-month follow-up, the patient had no complaints of discomfort with no relapse of pulmonary lesions.Lessons:Physicians should consider CEP as a diagnosis in patients who have had previous exposure to trastuzumab and radiation therapy, especially with a history of asthma. Timely diagnosis and treatment may benefit these patients.

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Eosinophilic Lung Diseases

Cottin¹,

Cordier²

2016

Murray and Nadel's Textbook of Respiratory Medicine

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Chronic Eosinophilic Pneumonia in a Breast Cancer Patient Post-Radiation Therapy: A Case Report

Cited by 5 publications

References 18 publications

Occurrence of pneumonitis following radiotherapy of breast cancer – A prospective study

Occurrence of pneumonitis following radiotherapy of breast cancer – A prospective study

Chronic eosinophilic pneumonia after trastuzumab and radiation therapy for breast cancer

Eosinophilic Lung Diseases

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