Migratory organizing pneumonitis "primed" by radiation therapy

Abstract

M Mi ig gr ra at to or ry y oor rg ga an ni iz zi in ng g p pn ne eu um mo on ni it ti is s " "p pr ri im me ed d" " b by y r ra ad di ia at ti io on n t th he er ra ap py y J-Y. Bayle*, P. Nesme*, F. Béjui-Thivolet**, R. Loire + , J.C. Guérin*, J.F. Cordier ++ Migratory organizing pneumonitis "primed" by radiation therapy. J-Y. Bayle, P. Nesme, F. Béjui-Thivolet, R. Loire, J.C. Guérin, J.F. Cordier. ©ERS Journals Ltd 1995. ABSTRACT: We report on two women presenting with cough and fever, 4 and 7 months, respectively, after starting breast radiation therapy following surgery for breast carcinoma. Chest roentgenogram and computed tomographic (CT) scan demonstrated alveolar opacities, initially limited to the pulmonary area next to the irradiated breast, but later migrating within both lungs. Intra-alveolar granulation tissue was found in transbronchial lung biopsies. Corticosteroid treatment resulted in dramatic clinical improvement, together with complete clearing of the pulmonary opacities on chest imaging. However, clinical and imaging relapses occurred when corticosteroids were withdrawn too rapidly; with further improvement when they were reintroduced.The reported cases clearly differ from radiation pneumonitis. They were fairly typical of cryptogenic organizing pneumonitis, also called idiopathic bronchiolitis obliterans organizing pneumonia, with the exception of the radiation therapy, partially affecting the lung, which had been performed within the previous months. Since focal radiation therapy involving the lung may induce diffuse bilateral lymphocytic alveolitis, we hypothesize that this may "prime" the lung to further injury, leading to cryptogenic organizing pneumonitis.

Migratory pulmonary infiltrates in a patient treated with sotalol

“…Although free intervals of up to 18 yrs have occasionally been reported [19], we believe that lengthy intervals such as these cast doubt on the reality of an association between radiation therapy and BOOP. The extent to which prior radiation therapy acted as a "priming" factor in our case, as suggested by others [16], remains unknown. Again, we want to stress that remission of clinical symptoms (particularly dry cough), and of radiographic opacities could only be obtained when sotalol was stopped.…”

“…Indeed, some cases of BOOP have been described following radiation therapy for breast carcinoma [16][17][18], although this complication is far less common than classic radiation pneumonitis or fibrosis. In the patient, the interval between the end of radiation therapy on the one hand, and the development of BOOP on the other, was 4 yrs.…”

Corticosteroid Refractory Radiation Pneumonitis that Remarkably Responded to Cyclosporin A.

“…Currently,an immunologically mediated mechanism seems to bemostplausible.Onesuggestion hasbeenthat the initial localradiation damage may causethereleaseofautoantigens that are recognized byactivatedpulmonary lymphocytes. The actionof theselymphocytes leadsto the development ofa diffuse bilateral lymphocytic alveolitis (14,15). In addition, Gibsonet al reportedthat animmunologically mediated mechanismsuchas hypersensitivity pneumonitis mayexplaintheinjury both in irradiated and unirradiated lung (16).…”

Effects of sivelestat sodium hydrate on the reduction of radiation pneumonitis

“…Consequently, we should be alert to the possibility of this condition when conducting radiation treatment (1). Despite reports showing the efficacy of steroid therapy for acute radiation pneumonitis, so far no treatment has been established scientifically (2)(3)(4)(5).…”