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1 May 1993 | Volume 118 Issue 9 | Pages 696-700
Objective: To determine if unilateral thoracic irradiation results in a lymphoid alveolitis in both irradiated and unirradiated lung fields.
Design: A prospective, nonrandomized study.
Patients: 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.
Measurements: History, physical examination, chest radiograph, quantitative gallium lung scanning, respiratory function tests, bronchoalveolar lavage, and lavage lymphocyte subset analysis.
Results: 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.
Conclusion: 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.
Author and Article Information
From St. Vincent's Hospital, University of New South Wales, and from Macquarie University, Sydney, Australia.
ARTICLE
Radiation Pneumonitis: A Possible Lymphocyte-mediated Hypersensitivity Reaction
Requests for Reprints: Samuel N. Breit, MD, Centre for Immunology, St. Vincent's Hospital and University of NSW, Sydney, 2010, Australia.
Grant Support: In part by grants from The National Health & Medical Research Council of Australia and from St. Vincent's Hospital, Sydney, Australia.
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