The Drug-Induced Respiratory Disease Website and App

Radiation therapy to the chest

I.e. radiation therapy to the chest, mediastinum, supraclavicula fossae or breast. See also under other radiation therapy headings including SBRT. Radiation therapy techniques have changed in the past decades. More adverse effects were observed in the past following 67Co radiation therapy. Reviews at PMID 10682772, 12932614, 23473474, 23583253, 23876528, 23972736. Chemotherapy sensitizes the lung to the effects of radiation (PMID 12118569) and vice versa. Incidence of radiation pneumonitis following reirradiation may be greater than for 'first-hand' irradiation (PMID: 25841506)

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.a

Pneumonitis (ILD), acute and/or severe (may produce the ARDS pattern)

I.b

Pneumonitis (interstitial lung disease/ILD)

I.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.d

Organizing pneumonia pattern (an area or areas of consolidation on imaging)

I.g

Pulmonary fibrosis

I.h

Subclinical pulmonary infiltrates/ILD

I.k

Lung nodule or nodules

I.l

Diffuse alveolar damage (DAD) (see alsoo under IIb and XVf)

I.o

Focal/localized area of pneumonitis/fibrosis

I.v

Abnormal lung function/pulmonary physiology (PFTs) without necessarily imaging or clinical evidence

I.x

Pleuroparenchymal fibroelastosis (PPFE)

I.y

Progression, acceleration or exacerbation of preexisting ILD/fibrosis

II - Pulmonary edema - Acute lung injury - ARDS

II.b

ARDS - Acute lung injury

III - Pulmonary/alveolar/airway hemorrhage/bleeding

III.h

Major/massive hemoptysis

IV - Airway involvement

IV.m

Bronchial stenosis/stricture

V - Pleural and/or pericardial involvement

V.a

Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

V.c

Pleural thickening - Fibrothorax

V.f

Pneumothorax

V.h

Chylothorax

V.k

Pleural calcifications

VI - Pulmonary vasculopathy

VI.c

Pulmonary veno-occlusive disease

VI.x

Pulmonary lymphangiectasis

VII - Mediastinal involvement

VII.d

Fibrosing mediastinitis

VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement

VIII.c

Upper airway obstruction other than angioedema or hematoma

VIII.r

Tracheal/large airway necrosis, chondronecrosis, perforation

VIII.t

Vocal cord paresis/paralysis

VIII.ab

Airway (e.g. tracheoesophageal) fistula

VIII.au

Large airway necrosis

IX - Neuromuscular / CNS involvement - Disordered breathing (during sleep)

IX.j

Phrenic nerve injury - Hemi- or bilateral diaphragmatic paralysis

XI - Miscellaneous

XI.b

Chest pain (acute or subacute), lone or prominent

XI.w

Cavitation/necrosis of lung tumor or metastases

XI.ag

Vertebral compression fracture

XII - Cardiovascular involvement / toxicity

XII.b

Valvular heart disease and/or dysfunction

XII.k

Constrictive pericarditis - Pericardial thickening

XII.o

Coronary artery disease (subacute, chronic)

XII.s

Heart block (bundle branch- or AV-)

XIII - Neoplastic conditions

XIII.e

Breast cancer

XV - Pathology

XV.c

Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)

XV.f

Path: Diffuse alveolar damage (DAD-pattern) (see also IL)

XV.h

Path: NSIP-fibrotic pattern

XV.i

Path: Pneumocyte atypia (reactive epithelial cells) (a.k.a. the "Napoleon Hat" sign)

XV.bm

Path: Diffuse lymphangiectasis

XVI - Imaging

XVI.bl

Imaging: An area or areas of avid tracer uptake in the lung/chest on 18F-PET scan

XVII - Infections & related conditions

XVII.e

Pneumocystis jiroveci pneumonia

XVII.af

Reactivation of a prior pulmonary infection (TB, melioidosis)

XIX - Cytological, biochemical features of/in BAL, pleural fluid or FNA

XIX.a

BAL: An excess proportion of lymphocytes

XXVII - Esophageal involvement

XXVII.a

Esophageal pathology (erosion, ulcer, tear, rupture, fistula)

XXVII.b

Esophageal toxicity

XXVII.c

Esophageal dysmotility