title: Radiation recall pneumonitis caused by erlotinib after palliative definitive radiotherapy.
abstract: BACKGROUND
  Radiation recall pneumonitis (RRP) occurs in a previously irradiated field and is triggered by certain cytotoxic drugs, principally chemotherapeutic agents such as erlotinib. Erlotinib is a reversible epidermal growth factor receptor tyrosine kinase inhibitor (TKI) and is an effective second-line treatment for patients with advanced-stage non-squamous-cell lung cancer. Previously, only 2 cases of radiation recall after erlotinib treatment have been reported. Here, we report a case of RRP caused by treatment with erlotinib 4 months after palliative definitive hypofractionated radiation therapy (RT).
  
  
  METHODS
  A 58-year-old male patient with non-small cell lung cancer (adenocarcinoma) was treated with polychemotherapy, palliative RT (30 Gy in 10 fractions), and erlotinib thereafter.
  
  
  RESULTS
  Dosimetric analysis obtained from a 3-dimensional conformal RT planning system revealed that the volume of lung receiving at least 20 Gy (V20) was 21.2% and the mean lung dose was 12.7 Gy. These data indicate that systemic administration of a TKI, even after palliative RT, may lead to unexpected toxicity when the radiation field encompasses visceral organs.
  
  
  CONCLUSIONS
  We conclude that the use of a TKI after RT may trigger radiation pneumonitis. Although evidence is limited, we advise clinicians to be cautious of RRP after erlotinib treatment.
authors.affiliation: Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana Research and Treatment Center, Adana, Turkey. hcemonal@hotmail.com
authors.forename: Cem
authors.initials: C
authors.lastname: Onal
authors.forename: Huseyin
authors.initials: H
authors.lastname: Abali
authors.forename: Zafer
authors.initials: Z
authors.lastname: Koc
authors.forename: Sibel
authors.initials: S
authors.lastname: Kara
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D000069347:Erlotinib Hydrochloride; D006801:Humans; D008297:Male; D008875:Middle Aged; D011799:Quinazolines / Q000009:adverse effects*; D017564:Radiation Pneumonitis / Q000139:chemically induced*; D011836:Radiation Tolerance / Q000187:drug effects*; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride