Computed tomography patterns in patients with cytotoxic drug-induced pulmonary toxicity

Abstract

Background: Computed tomography (CT) appearance in pulmonary toxicity of antineoplastic drugs has various patterns. A diffuse alveolar damage (DAD) pattern on CT images was correlated with poor prognosis in patients with gefitinib-induced lung injury (Endo M, et al. Lung Cancer 2006; 52:135-140). However, the association between the CT findings and clinical outcomes remains unclear in cases of conventional cytotoxic drug-induced pulmonary toxicity (CDPT). Objectives: We aimed to analyze the imaging features of CT in cases of CDPT and to elucidate the relationship between the CT patterns and prognosis. Methods: We performed a retrospective review of 28 patients with CDPT at Chiba University Hospital from 2005 to 2015. Results: The CT findings of CDPT were classified into one of five predominant patterns; DAD ( n = 11), hypersensitivity pneumonitis (HP) ( n = 6), eosinophilic pneumonia (EP) ( n = 5), organizing pneumonia (OP) ( n = 4), and chronic interstitial pneumonia (CIP) ( n = 2). The 90-day mortality rate was significantly higher in the patients with a DAD pattern (DAD-group) than the patients without a DAD pattern (non-DAD group) (64% vs 6%, p = 0.0007). Serum levels of LDH, CRP and KL-6 were significantly elevated in the DAD group compared with the non-DAD group ( p = 0.029, 0.032 and 0.023, respectively). Univariate analyses revealed that a DAD pattern on CT images was the only significant factor for 90-day mortality ( p = 0.006). Conclusion: The CT findings with a DAD pattern indicate unfavorable outcomes in patients with CDPT. Classification of the CT patterns of CDPT into DAD or non-DAD seems to be practically useful to predict prognosis.