We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Radiation pneumonitis: a possible lymphocyte-mediated hypersensitivity reaction.
- Authors
Roberts, C. Michael; Foulcher, Elena; Zaunders, John J.; Bryant, David H.; Freund, Judy; Cairns, David; Penny, Ronald; Morgan, Graeme W.; Breit, Samuel N.; Roberts, C M; Foulcher, E; Zaunders, J J; Bryant, D H; Freund, J; Cairns, D; Penny, R; Morgan, G W; Breit, S N
- Abstract
<bold>Objective: </bold>To determine if unilateral thoracic irradiation results in a lymphoid alveolitis in both irradiated and unirradiated lung fields.<bold>Design: </bold>A prospective, nonrandomized study.<bold>Patients: </bold>Women receiving postoperative radiotherapy for carcinoma of the breast were evaluated both before and 4 to 6 weeks after radiotherapy. Findings after radiotherapy in 15 asymptomatic patients were compared with findings in a group of patients with clinical radiation pneumonitis.<bold>Measurements: </bold>History, physical examination, chest radiograph, quantitative gallium lung scanning, respiratory function tests, bronchoalveolar lavage, and lavage lymphocyte subset analysis.<bold>Results: </bold>After irradiation, lavage lymphocytes increased significantly (34.5% versus 46.8%; P = 0.01) in the 17 patients studied prospectively. There was an associated reduction in vital capacity (102.5% versus 95.5%; P = 0.04). Comparison of results in patients before treatment, after treatment without clinical pneumonitis, and after treatment with clinical pneumonitis showed a dramatic increase in total lymphocytes after irradiation (6.3 versus 9.4 versus 35.2 million, respectively; P = 0.005), particularly in those with clinical pneumonitis. Only in those with clinical pneumonitis was this accompanied by an increase in the gallium index (3.7 versus 3.4 versus 9.0, respectively; P < 0.001). Vital capacity was also progressively reduced (102.5% versus 96.9% versus 76.7%, respectively; P = 0.04), as was diffusing capacity (98.6% versus 91.4% versus 72.6%, respectively; P = 0.003). No statistical differences existed between irradiated and unirradiated sides of the chest in either lavage or gallium lung scan studies.<bold>Conclusion: </bold>In most patients, a lymphocytic alveolitis develops in both lung fields after strictly unilateral thoracic irradiation; this is more pronounced in patients developing clinical pneumonitis. These findings suggest that radiotherapy may cause a generalized lymphocyte-mediated hypersensitivity reaction.
- Subjects
CHEST diseases; RADIOTHERAPY; PNEUMONIA
- Publication
Annals of Internal Medicine, 1993, Vol 118, Issue 9, p696
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-118-9-199305010-00006