Spontaneous resolution of thoracic radiation therapy-induced organizing pneumonia: A case series

Abstract

We retrospectively analyzed the data of 9 patients with organizing pneumonia induced by radiation therapy. Radiation therapy had been administered for breast cancer in 8 patients and for lung cancer in 1 patient. Symptoms were detected in 8 patients; however, none of the patients developed hypoxemia or respiratory failure, and the clinical course was good. Steroid therapy was administered to 3 patients; however, all 3 patients developed recurrence. In contrast, none of the 6 patients who received symptomatic treatment developed recurrence. Steroid treatment is often provided for patients with organizing pneumonia; however, the effect of steroid administration on recurrence rate needs to be examined. In addition, none of the patients died and only 1 patient with lung cancer required mechanical ventilation. Therefore, considering the serious side effects of steroid use, initial symptomatic treatment, and not steroid administration, may be best for patients. One exception would be for patients with hypoxemia or those whose symptoms adversely affect the activities of daily living. The incidence of radiation therapy-induced organizing pneumonia in lung cancer patients is higher and its severity is greater than that in breast cancer patients; however, the time to onset may be longer in lung cancer patients. Therefore, more attention should be paid towards the diagnosis and treatment of radiation therapy-induced organizing pneumonia in patients with lung cancer as compared to that in patients with breast cancer.

Fig. 1

Computed tomography image course of case 1. (A) Consolidation outside the radiation field in the upper lobe on admission. (B) New consolidation was found in the left upper lobe one month after the end of steroid administration. (C) Consolidation was improved only by follow-up in 3 months.

Fig. 2

Computed tomography image course of case 2. (A) Consolidation was found outside of the radiation field in right lower lobe on admission. (B) Consolidation of the right lower lobe moved, and showed improvement 3 months later (black arrow). (C) Consolidation disappeared following symptomatic treatment in 5 months.