Post Chemo Lung Toxicity: A Less Visited Domain

Abstract

Background: Post-anticancer chemotherapy changes in lung parenchyma is an important and challenging aetiology for radiologists presenting not uncommonly in cancer patients. Early diagnosis of post-chemotherapy lung toxicity have serious implications on patient's health.Objective: To evaluate post-chemotherapy cancer patients for pulmonary toxicity and establish their association with frequency of chemotherapy cycles and time lapse since last cycle.Material and Methods: This retrospective study was conducted in Kuwait teaching Hospital from January 2018 till December 2018. A total of 204 patients were evaluated with age ranging from 3 to 78 years including 63 male and 141 female patients. Chest CT scan had been done on16 slice Toshiba CT scanner in Radiology department of Kuwait Teaching Hospital. Images were evaluated in axial, coronal and sagittal planes and in lung and soft tissue window on workstation. Data like patient age ,gender , malignancy , number of chemotherapy cycles received , time lapse since last chemotherapy cycle, common CT manifestations of lung toxicity and CT lung findings unrelated to chemotherapy regimens ;was collected and subjected to statistical analysis. Results: Out of the total 204 patients, who already had anticancer therapy, 135 patients (66.2%) did not show any pulmonary abnormality on CT chest . 11 patients (5.4%) showed chemotherapy related pulmonary findings on CT. 46 patients (22.5%) showed CT chest findings which were incidental and irrelevant to chemotherapy.12 patients (5.9%) had both chemotherapy related pulmonary toxicity changes and incidental findings. The types of post chemotherapy CT lung changes were divided into ground-glass haze, ground glass haze with bronchiectasis, ground glass haze with septal thickening giving crazy paving appearance, patches of consolidation and reticular thickening. 10 patients had sole finding of ground glass haze only (43.5%) whereas 4 patient showed ground glass haze with bronchiectatic changes(17.4 %) and 2 patients depicted a crazy paving appearance (8.7%). Significant association (p=0.00) was noted between number of chemotherapy cycles and above mentioned CT lung findings .No positive correlation was present between time lapse since last chemotherapy cycle and these CT lung findings. Conclusion: Ground glass attenuation was found to be the most profounding feature of post chemotherapy lung CT changes.