title: The risk of cytotoxic chemotherapy-related exacerbation of interstitial lung disease with lung cancer.
abstract: BACKGROUND
  It is unknown what type of interstitial lung disease (ILD) has high risk for chemotherapy-related exacerbation of ILD. We investigated the risk of exacerbation of ILD for patients with lung cancer with ILD.
  
  
  METHODS
  One hundred nine patients with lung cancer with ILD treated with cytotoxic chemotherapy at Shizuoka Cancer Center between August 2002 and April 2010 were retrospectively reviewed.
  
  
  RESULTS
  On pretreatment computed tomography (CT) of the chest, 69 patients (63%) were identified with usual interstitial pneumonia (UIP) pattern, and 40 patients (37%) had non-UIP pattern. Patients with UIP pattern developed cytotoxic chemotherapy-related exacerbation of ILD more frequently than those with non-UIP pattern (30 versus 8%, p = 0.005). The incidence of grade 5 pulmonary toxicities was 9% in patients with UIP pattern, compared with 3% in those with non-UIP pattern. Multivariate analyses demonstrated that age (<70 years) and CT pattern (UIP) were significant independent risk factors for cytotoxic chemotherapy-related exacerbation of ILD. In small cell lung cancer, overall survival (OS) from the start of first-line chemotherapy was significantly shorter in UIP pattern than non-UIP pattern (median OS: 9 versus 16 months, p = 0.0475), whereas there was no significant difference in patients with non-small cell lung cancer (median OS: 12 versus 9 months, p = 0.2529).
  
  
  CONCLUSIONS
  Our results indicated that the incidence of exacerbation of ILD was significantly higher in patients with lung cancer with UIP pattern on CT findings than in those with non-UIP pattern. Therefore, great care is required when administering cytotoxic chemotherapy agents for patients with lung cancer with UIP pattern.
authors.affiliation: Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Japan. h.kenmotsu@scchr.jp
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Kenmotsu
authors.forename: Tateaki
authors.initials: T
authors.lastname: Naito
authors.forename: Madoka
authors.initials: M
authors.lastname: Kimura
authors.forename: Akira
authors.initials: A
authors.lastname: Ono
authors.forename: Takehito
authors.initials: T
authors.lastname: Shukuya
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Asuka
authors.initials: A
authors.lastname: Tsuya
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Kaira
authors.forename: Haruyasu
authors.initials: H
authors.lastname: Murakami
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Endo
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yamamoto
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000188:drug therapy; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000188:drug therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011658:Pulmonary Fibrosis / Q000139:chemically induced / Q000000981:diagnostic imaging; D015656:Respiratory Mechanics; D012189:Retrospective Studies; D012307:Risk Factors; D055752:Small Cell Lung Carcinoma / Q000150:complications* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed