Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Jun 10, 2017; 8(3): 285-288
Published online Jun 10, 2017. doi: 10.5306/wjco.v8.i3.285
Bilateral diffuse grade 5 radiation pneumonitis after intensity modulated radiation therapy for localized lung cancer
Virginia W Osborn, Andrea Leaf, Anna Lee, Elizabeth Garay, Joseph Safdieh, David Schwartz, David Schreiber
Virginia W Osborn, Andrea Leaf, Anna Lee, Elizabeth Garay, Joseph Safdieh, David Schwartz, David Schreiber, Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY 11209, United States
Virginia W Osborn, Anna Lee, Elizabeth Garay, Joseph Safdieh, David Schwartz, David Schreiber, SUNY Downstate Medical Center, Brooklyn, NY 11203, United States
Author contributions: Osborn VW and Schreiber D analyzed case; Osborn VW, Leaf A, Lee A, Garay E, Safdieh J, Schwartz D and Schreiber D wrote and edited the paper.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: David Schreiber, MD, Attending Physician, Veterans Affairs New York Harbor Healthcare System, 800 Poly Place, 114A, Brooklyn, NY 11209, United States. david.schreiber@va.gov
Telephone: +1-718-6303605 Fax: +1-718-6302857
Received: March 9, 2017
Peer-review started: March 13, 2017
First decision: March 27, 2017
Revised: May 2, 2017
Accepted: May 12, 2017
Article in press: May 15, 2017
Published online: June 10, 2017
Processing time: 84 Days and 19.7 Hours
Abstract

We are reporting a case of fatal radiation pneumonitis that developed six months following chemoradiation for limited stage small cell lung cancer. The patient was a 67-year-old man with a past medical history of Hashimoto’s thyroiditis and remote suspicion for CREST, neither of which were active in the years leading up to treatment. He received 6600 cGy delivered in 200 cGy daily fractions via intensity modulated radiation therapy with concurrent cisplatin/etoposide followed by additional chemotherapy with dose-reduced cisplatin/etoposide and carboplatin/etoposide and then received prophylactic cranial irradiation. The subsequent months were notable for progressively worsening episodes of respiratory compromise despite administration of prolonged steroids and he ultimately expired. Imaging demonstrated bilateral interstitial and airspace opacities. Autopsy findings were consistent with pneumonitis secondary to chemoradiation as well as lymphangitic spread of small cell carcinoma. The process was diffuse bilaterally although his radiation was delivered focally to the right lung and mediastinum.

Keywords: Radiation; Pneumonitis; Small cell lung cancer; Intensity modulated radiation therapy

Core tip: Radiation pneumonitis is an uncommon but serious complication from radiation therapy which can on rare occasions be fatal. This report not only documents the details of such a case but also includes pathologic confirmation and computed tomography images. Although the radiation field was limited to the right lung and mediastinum, the process was also noted to be bilateral and diffuse.