Radiation Recall Pneumonitis During Systemic Treatment With Everolimus

Abstract

Radiation recall syndrome is an acute inflammatory reaction developing at anatomical sites of previously irradiated tissue, weeks to months after the completion of radiation therapy. The distribution pattern of inflammation typically involves, and remains limited to, the boundaries of prior radiation treatment fields. Several classical chemotherapy drugs have been reported to have the potential for causing radiation recall syndrome. With the increasing availability and expanding use of novel biologic and targeted therapy anticancer drugs, isolated reports of radiation recall syndrome secondary to this class of agents are starting to appear in the literature. We describe a case of everolimus-induced radiation recall pneumonitis in a patient with metastatic renal cell cancer.

Figure 1

(A) Radiation isodose treatment fields on pretreatment planning CT scan: red line 100% dose, purple line 70%, orange line 50%. (B) Pneumonitis developing in previously radiated lung fields 1 month after the start of everolimus treatment, 2 months after the completion of radiation treatment. (C) Progression of pneumonitis in previously radiated lung fields. (D) Interval resolution of diffuse infiltrates in the left lung at 12 weeks of follow-up.

Figure 2

(A) Radiation isodose treatment fields on pretreatment planning CT scan: red line 100% dose, purple line 70%, orange line 50%. (B) Pneumonitis developing in previously radiated lung fields 1 month after the start of everolimus treatment, 2 months after the completion of radiation treatment. (C) Progression of pneumonitis in previously radiated lung fields. (D) Interval resolution of diffuse infiltrates in the left lung at 12 weeks of follow-up.