title: Corticosteroid therapy against treatment-related pulmonary toxicities in patients with lung cancer.
abstract: BACKGROUND
  With the recent increased use of new anti-neoplastic agents, molecular-targeted drugs and radiation in patients with lung cancer, there has been an increase in the occurrence drug-induced or radiation-induced pulmonary toxicities. We conducted this study to evaluate the clinical characteristics of patients with lung cancer who presented with treatment-related pulmonary toxicities and to analyze the dosage pattern of corticosteroid therapy against them.
  
  
  METHODS
  To collect the baseline data from the patients with lung cancer who developed treatment-related pulmonary toxicities, we initially selected those who were prescribed corticosteroids between January 1, 2008 and December 31, 2012. Depending on clinical and radiological diagnoses, we classified pulmonary toxicities into drug-induced interstitial lung disease (DILD), radiation pneumonitis, acute exacerbation of chronic obstructive pulmonary disease (AE COPD) and others.
  
  
  RESULTS
  We divided total patients (n=398) into four groups, and these include 88 cases (22%) of DILD, 189 cases (47%) of radiation pneumonitis, 47 cases (12%) of AE COPD and 74 cases (19%) of others. The prescribed rate of pulse or high-dose steroid was measured as 73%, 20%, 40% and 38%, respectively (P<0.001). In DILD radiologic findings, the 2-month mortality was significantly higher in the patients with the diffuse alveolar damage (DAD) pattern (100%) as compared with those with the non-specific interstitial pneumonia (NSIP) or bronchiolitis obliterans with organizing pneumonia (BOOP) one (62% or 42%, respectively) (P=0.032).
  
  
  CONCLUSIONS
  This study showed that the natural course of DILD had more unfavorable outcome requiring higher dose steroid therapy as compared with those with radiation pneumonitis or AE COPD. According to a subgroup analysis of the patients with DILD, BOOP and NSIP radiographic patterns showed more favorable outcomes.
authors.affiliation: 1 Department of Family Medicine, 2 Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea ; 3 Department of Internal Medicine, 4 Department of Radiology, Chonnam National University, Gwangju, Republic of Korea.
authors.forename: Sun
authors.initials: S
authors.lastname: Kim
authors.affiliation: 1 Department of Family Medicine, 2 Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea ; 3 Department of Internal Medicine, 4 Department of Radiology, Chonnam National University, Gwangju, Republic of Korea.
authors.forename: In-Jae
authors.initials: IJ
authors.lastname: Oh
authors.affiliation: 1 Department of Family Medicine, 2 Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea ; 3 Department of Internal Medicine, 4 Department of Radiology, Chonnam National University, Gwangju, Republic of Korea.
authors.forename: Seo-Yeon
authors.initials: SY
authors.lastname: Park
authors.affiliation: 1 Department of Family Medicine, 2 Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea ; 3 Department of Internal Medicine, 4 Department of Radiology, Chonnam National University, Gwangju, Republic of Korea.
authors.forename: Jang-Hyeon
authors.initials: JH
authors.lastname: Song
authors.affiliation: 1 Department of Family Medicine, 2 Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea ; 3 Department of Internal Medicine, 4 Department of Radiology, Chonnam National University, Gwangju, Republic of Korea.
authors.forename: Hyun-Ju
authors.initials: HJ
authors.lastname: Seon
authors.affiliation: 1 Department of Family Medicine, 2 Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea ; 3 Department of Internal Medicine, 4 Department of Radiology, Chonnam National University, Gwangju, Republic of Korea.
authors.forename: Yun-Hyeon
authors.initials: YH
authors.lastname: Kim
authors.affiliation: 1 Department of Family Medicine, 2 Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea ; 3 Department of Internal Medicine, 4 Department of Radiology, Chonnam National University, Gwangju, Republic of Korea.
authors.forename: Seong-Hoon
authors.initials: SH
authors.lastname: Yoon
authors.affiliation: 1 Department of Family Medicine, 2 Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea ; 3 Department of Internal Medicine, 4 Department of Radiology, Chonnam National University, Gwangju, Republic of Korea.
authors.forename: Jin-Yeong
authors.initials: JY
authors.lastname: Yu
authors.affiliation: 1 Department of Family Medicine, 2 Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea ; 3 Department of Internal Medicine, 4 Department of Radiology, Chonnam National University, Gwangju, Republic of Korea.
authors.forename: Bo-Ram
authors.initials: BR
authors.lastname: Lee
authors.affiliation: 1 Department of Family Medicine, 2 Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea ; 3 Department of Internal Medicine, 4 Department of Radiology, Chonnam National University, Gwangju, Republic of Korea.
authors.forename: Kyu-Sik
authors.initials: KS
authors.lastname: Kim
authors.affiliation: 1 Department of Family Medicine, 2 Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea ; 3 Department of Internal Medicine, 4 Department of Radiology, Chonnam National University, Gwangju, Republic of Korea.
authors.forename: Young-Chul
authors.initials: YC
authors.lastname: Kim
keywords: Corticosteroids; drug-induced interstitial lung disease (DILD); lung cancer; pulmonary toxicity; radiation pneumonitis