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CC BY-NC-ND 4.0 · South Asian J Cancer 2021; 10(04): 255-260
DOI: 10.1055/s-0041-1731581
Original Article: Lung Cancer

Chemotherapy-Associated Pulmonary Toxicity—Case Series from a Single Center

Tilak TVSVGK 
1   Department of Internal Medicine, Armed Forces Medical College (AFMC), Pune, Maharashtra, India
,
Ajay Handa
2   Department of Medicine, INHS Asvini, Mumbai, Maharashtra, India
,
Kishore Kumar
3   Department Medicine, Command Hospital Air Force (CHAF), Bangalore, Karnataka, India
,
Deepti Mutreja
4   Department of Pathology, Armed Forces Medical College (AFMC), Pune, Maharashtra, India
,
Shankar Subramanian
1   Department of Internal Medicine, Armed Forces Medical College (AFMC), Pune, Maharashtra, India
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Abstract

Background Pulmonary toxicity due to chemotherapeutic agents can occur with many established and new drugs. Strong clinical suspicion is important as the clinical presentation is usually with nonspecific symptoms like cough, dyspnea, fever, and pulmonary infiltrates. Timely discontinuation of the offending agent alone can improve the condition.

Methods A prospective observational study on patients receiving chemotherapy at an 800-bedded tertiary care hospital was performed from 2014 to 2016. Consecutive patients on chemotherapy, presenting with nonresolving respiratory symptoms were evaluated with contrast-enhanced computerized tomography of chest, diffusion lung capacity for carbon monoxide (DLCO), fiberoptic bronchoscopy with lavage, and biopsy, after excluding all causes for pulmonary infections. Descriptive data has been depicted.

Results A total of 18 patients were evaluated for persistent symptoms of dry cough, dyspnea, and fever among 624 who received chemotherapy during the study period. Ground-glass opacities on high-resolution CT was the most common imaging finding, others being patchy subpleural consolidation and pleural effusion. Lymphocyte-predominant bronchoalveolar lavage was detected in nine. Eight of the 15 patients who underwent DLCO, had abnormal results. Seven had significant histopathological findings on bronchoscopic lung biopsy, which revealed organizing pneumonia as the most common pattern. Paclitaxel, fluorouracil, gemcitabine, and tyrosine kinase inhibitors were the common culprit drugs. Discontinuation alone of the culprit drug was effective in 15 and 3 needed oral corticosteroids for relief of symptoms. None of the patients died due to the toxicity.

Conclusion An incidence of 2.8% for chemotherapy-induced lung injury was seen in our observational study of 3 years, with parenchymal, interstitial, and pleural involvement due to various chemotherapeutic agents. Oral steroids maybe required in a subset of patients not responding to discontinuation of the culprit agent.

Keywords

chemotherapy-associated pulmonary toxicity - ground-glass opacities - transbronchial lung biopsy - organizing pneumonia


Publication History

Article published online:
11 November 2021

© 2021. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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