PDF(Pubmed)
Abstract：
BACKGROUND: Radiation recall pneumonitis (RRP) is a poorly understood clinical syndrome in which patients develop radiation pneumonitis triggered by a systemic agent, often years after the completion of radiation therapy. Immune checkpoint blockade agents have only recently been posited as a trigger for RRP. Here, we present three cases of immunotherapy-induced RRP.
METHODS: Our first patient was diagnosed with primary lung adenocarcinoma, and 4.5 years after completing radiation therapy developed symptomatic RRP immediately following a second dose of nivolumab-containing immunotherapy regimen. Our second patient was diagnosed with primary bladder cancer metastatic to the mediastinum, which was treated twice with radiation therapy. He developed RRP in the days following his second course of ipilimumab-pembrolizumab which was months after his second course of radiation that he received. Our final patient was diagnosed with metastatic small cell lung cancer and received local consolidative radiation therapy in addition to whole-brain radiation. He developed RRP on the 11th day after concluding his 4th cycle of nivolumab-ipilimumab, approximately 7 months after having had completed chest radiation therapy.
CONCLUSIONS: Immunotherapy-induced RRP is a rare diagnosis which can present more focally than traditional immunotherapy pneumonitis and which must be clinically differentiated from other local processes such as pneumonia. Further research should explore the mechanisms underlying these radiation recall reactions as many patients receive radiation and immunotherapy during the course of their cancer treatment.
METHODS: Our first patient was diagnosed with primary lung adenocarcinoma, and 4.5 years after completing radiation therapy developed symptomatic RRP immediately following a second dose of nivolumab-containing immunotherapy regimen. Our second patient was diagnosed with primary bladder cancer metastatic to the mediastinum, which was treated twice with radiation therapy. He developed RRP in the days following his second course of ipilimumab-pembrolizumab which was months after his second course of radiation that he received. Our final patient was diagnosed with metastatic small cell lung cancer and received local consolidative radiation therapy in addition to whole-brain radiation. He developed RRP on the 11th day after concluding his 4th cycle of nivolumab-ipilimumab, approximately 7 months after having had completed chest radiation therapy.
CONCLUSIONS: Immunotherapy-induced RRP is a rare diagnosis which can present more focally than traditional immunotherapy pneumonitis and which must be clinically differentiated from other local processes such as pneumonia. Further research should explore the mechanisms underlying these radiation recall reactions as many patients receive radiation and immunotherapy during the course of their cancer treatment.
摘要：
背景：放射性召回性肺炎（RRP）是一种鲜为人知的临床综合征，患者会出现由全身性药物引发的放射性肺炎，通常在放射治疗完成后几年。免疫检查点阻断剂直到最近才被认为是RRP的触发剂。这里,我们介绍了3例免疫治疗诱导的RRP。
方法：我们的第一例患者被诊断为原发性肺腺癌，完成放射治疗4.5年后,在第二剂含纳武单抗的免疫治疗方案后立即出现有症状的RRP.我们的第二个病人被诊断为原发性膀胱癌转移到纵隔，接受了两次放射治疗。他在第二个疗程的ipilimumab-pembrolizumab后的几天内发展了RRP，这是他接受第二个疗程的几个月后。我们的最终患者被诊断为转移性小细胞肺癌，除全脑放疗外，还接受了局部巩固放疗。他在结束了他的第4个周期的nivolumab-ipilimumab后的第11天开发了RRP，完成胸部放射治疗后约7个月.
结论：免疫疗法诱导的RRP是一种罕见的诊断，比传统的免疫疗法引起的肺炎更为严重，必须在临床上与其他局部过程如肺炎区分开来。进一步的研究应该探索这些辐射回忆反应的潜在机制，因为许多患者在癌症治疗过程中接受了辐射和免疫疗法。
方法：我们的第一例患者被诊断为原发性肺腺癌，完成放射治疗4.5年后,在第二剂含纳武单抗的免疫治疗方案后立即出现有症状的RRP.我们的第二个病人被诊断为原发性膀胱癌转移到纵隔，接受了两次放射治疗。他在第二个疗程的ipilimumab-pembrolizumab后的几天内发展了RRP，这是他接受第二个疗程的几个月后。我们的最终患者被诊断为转移性小细胞肺癌，除全脑放疗外，还接受了局部巩固放疗。他在结束了他的第4个周期的nivolumab-ipilimumab后的第11天开发了RRP，完成胸部放射治疗后约7个月.
结论：免疫疗法诱导的RRP是一种罕见的诊断，比传统的免疫疗法引起的肺炎更为严重，必须在临床上与其他局部过程如肺炎区分开来。进一步的研究应该探索这些辐射回忆反应的潜在机制，因为许多患者在癌症治疗过程中接受了辐射和免疫疗法。
