Radiation recall pneumonitis triggered by an immune checkpoint inhibitor following re-irradiation in a lung cancer patient: a case report

BMC Pulmonary Medicine

Ling Peng¹  Xianghua Ye²  Jinsong Yang²  Justin Stebbing³ 

[1] Cancer Center, Department of Pulmonary and Critical Care Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, 310014, Hangzhou, Zhejiang Province, China;Department of Radiotherapy, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China;Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK;

关键词: Radiation recall pneumonitis;    Radiotherapy;    Immunotherapy;    NSCLC;   

DOI  :  10.1186/s12890-022-01846-x

来源: Springer

【 摘 要 】

BackgroundRadiation recall pneumonitis (RRP) is unpredictable but associated with severe radiation damage in previously irradiated fields. Chemotherapy and targeted drugs have been reported to contribute to RRP. Here we report a case of a patient with non-small cell lung cancer (NSCLC) who developed RRP following administration of immune checkpoint inhibitor (ICI) 18 months after the end of re-irradiation.Case presentationA 69-year-old man received adjuvant chemoradiotherapy post-operatively. He underwent thoracic re-irradiation for oligometastatic NSCLC. On second recurrence, pembrolizumab combined with nab-paclitaxel were administered. After six months, he developed symptoms of persistent cough and dyspnea, with consistent pneumonitis on CT images. The clinical time frame and significant radiographic evidence raised suspicion for RRP. Symptoms resolved after steroids.ConclusionsRRP is a rare occurrence. Patients undergoing immunotherapy after prior irradiation may be at increased risk of this rare radiation pneumonitis.

【 授权许可】

CC BY