Corticosteroid therapy against treatment-related pulmonary toxicities in patients with lung cancer

Abstract

Background: With the recent increased use of new anti-neoplastic agents, molecular-targeted drugs and radiation in patients with lung cancer, there has been an increase in the occurrence drug-induced or radiation-induced pulmonary toxicities. We conducted this study to evaluate the clinical characteristics of patients with lung cancer who presented with treatment-related pulmonary toxicities and to analyze the dosage pattern of corticosteroid therapy against them.

Methods: To collect the baseline data from the patients with lung cancer who developed treatment-related pulmonary toxicities, we initially selected those who were prescribed corticosteroids between January 1, 2008 and December 31, 2012. Depending on clinical and radiological diagnoses, we classified pulmonary toxicities into drug-induced interstitial lung disease (DILD), radiation pneumonitis, acute exacerbation of chronic obstructive pulmonary disease (AE COPD) and others.

Results: We divided total patients (n=398) into four groups, and these include 88 cases (22%) of DILD, 189 cases (47%) of radiation pneumonitis, 47 cases (12%) of AE COPD and 74 cases (19%) of others. The prescribed rate of pulse or high-dose steroid was measured as 73%, 20%, 40% and 38%, respectively (P<0.001). In DILD radiologic findings, the 2-month mortality was significantly higher in the patients with the diffuse alveolar damage (DAD) pattern (100%) as compared with those with the non-specific interstitial pneumonia (NSIP) or bronchiolitis obliterans with organizing pneumonia (BOOP) one (62% or 42%, respectively) (P=0.032).

Conclusions: This study showed that the natural course of DILD had more unfavorable outcome requiring higher dose steroid therapy as compared with those with radiation pneumonitis or AE COPD. According to a subgroup analysis of the patients with DILD, BOOP and NSIP radiographic patterns showed more favorable outcomes.

Keywords: Corticosteroids; drug-induced interstitial lung disease (DILD); lung cancer; pulmonary toxicity; radiation pneumonitis.

Figures

Figure 1

The selection and classification of the patients based on the CONSORT flow chart. Abbreviations: CONSORT, Consolidated Standards of Reporting Trials; ICP, intracranial pressure; ILD, interstitial lung disease; AE COPD, acute exacerbation of chronic obstructive pulmonary disease.

Figure 2

Computed tomography (CT) findings of drug-induced interstitial lung disease. (A) Nonspecific interstitial pneumonia pattern shows bilateral patchy areas of ground glass opacity, accompanied by some thickening of interlobular septa and minimal bronchiectasis; (B) bronchiolitis obliterans organizing pneumonia pattern shows multifocal peripheral areas of peribronchial consolidation and bronchial wall thickening; (C) diffuse alveolar damage (DAD) pattern shows diffuse thickening of interlobular septa, scattered areas of ground glass opacity and right pleural effusion; (D) mixed pattern (diffuse alveolar pattern and radiation pneumonitis) shows bilateral patchy areas of consolidation and perilesional ground glass opacities in both lungs, mixed with volume loss in the left upper lobe.