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 (interstitial lung disease/ILD)

I.b

Pneumonitis (ILD), acute and/or severe (may cause ARDS)

I.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.e

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

I.g

Pulmonary fibrosis

I.i

Subclinical pulmonary infiltrates/ILD

I.l

Lung nodule or nodules

I.m

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

I.p

Focal/localized area of pneumonitis/fibrosis

I.w

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

I.y

Pleuroparenchymal fibroelastosis (PPFE)

I.z

Progression, acceleration or exacerbation of preexisting ILD/fibrosis

XLI - Pulmonary edema - Acute lung injury - ARDS

XLI.e

ARDS - Acute lung injury

XLII - Pulmonary/alveolar./airway hemorrhage/bleeding

XLII.h

Major/massive hemoptysis

XLIII - Airway involvement

XLIII.ai

Bronchial stenosis/stricture

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

XLIV.c

Upper airway obstruction other than angioedema or hematoma

XLIV.g

Vocal cord paresis/paralysis

XLIV.s

Tracheal/large airway necrosis, chondronecrosis, perforation

XLIV.ab

Airway (e.g. tracheoesophageal) fistula

XLIV.ac

Large airway necrosis

XLV - Pleural and/or pericardial involvement

XLV.a

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

XLV.c

Pleural thickening - Fibrothorax

XLV.f

Pneumothorax

XLV.h

Chylothorax

XLV.k

Pleural calcifications

XLVI - Pulmonary vasculopathy

XLVI.c

Pulmonary veno-occlusive disease

XLVI.w

Pulmonary lymphangiectasis

XLVII - Mediastinal involvement

XLVII.d

Fibrosing mediastinitis

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

XLVIII.j

Phrenic nerve injury - Hemi- or bilateral diaphragmatic paralysis

L - Miscellaneous

L.b

Chest pain (acute or subacute), lone or prominent

L.t

Cavitation/necrosis of lung tumor or metastases

L.ad

Vertebral compression fracture

LI - Cardiovascular involvement / toxicity

LI.b

Valvular heart disease and/or dysfunction

LI.l

Constrictive pericarditis - Pericardial thickening

LI.p

Coronary artery disease (subacute, chronic)

LI.t

Heart block (bundle branch- or AV-)

LII - Esophageal involvement

LII.b

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

LII.d

Esophageal toxicity

LII.e

Esophageal dysmotility

LV - Imaging

LV.bp

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

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

LVII.a

BAL: An excess proportion of lymphocytes

LVIII - Pathology

LVIII.d

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

LVIII.o

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

LVIII.q

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

LVIII.v

Path: NSIP-fibrotic pattern

LVIII.cg

Path: Diffuse lymphangiectasis

LIX - Infections & related conditions

LIX.e

Pneumocystis jiroveci pneumonia

LIX.ae

Reactivation of a prior pulmonary infection (TB, melioidosis)

LX - Neoplastic conditions

LX.e

Breast cancer