title: Radiation recall pneumonitis induced by epidermal growth factor receptor-tyrosine kinase inhibitor in patients with advanced nonsmall-cell lung cancer.
abstract: BACKGROUND
  Radiation recall pneumonitis (RRP) is a special form of radiation pneumonitis precipitated by certain pharmacological agents. Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) is an effective treatment for advanced nonsmall-cell lung cancer (NSCLC) and has been reported as a potent radiation sensitizer. The incidence and general characteristics of EGFR-TKI-related RRP in patients with NSCLC remain unclear.
  
  
  METHODS
  Clinical records and serial chest images of consecutive patients with advanced NSCLC who had received thoracic radiotherapy (TRT) and EGFR-TKI treatment were retrospectively reviewed. EGFR-TKI-related RRP was diagnosed according to history, clinical manifestations, and radiographic characteristics. Potential risk factors were analyzed.
  
  
  RESULTS
  In total, 160 patients with NSCLC who received EGFR-TKI after TRT were identified. Of these patients, seven (4.4%) developed EGFR-TKI-related RRP. The median time interval between the end of radiotherapy and RRP was 124 days (range, 80-635 days) and that between the initiation of EGFR-TKI and RRP was 43 days (range, 18-65 days). No risk factor for the development of RRP was identified except that patients in whom EGFR-TKI was initiated within 90 days after the completion of radiotherapy had significantly higher rates of RRP than those of patients who began receiving EGFR-TKI treatment after 90 days (21% vs. 2.1%, p = 0.005).
  
  
  CONCLUSIONS
  In patients with NSCLC who have a history of TRT, treatment with EGFR-TKI may induce not only interstitial lung disease but also RRP. Physicians should be aware of both unexpected adverse events when using EGFR-TKI.
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Chi-Lu
authors.initials: CL
authors.lastname: Chiang
authors.affiliation: Division of Radiotherapy, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Yi-Wei
authors.initials: YW
authors.lastname: Chen
authors.affiliation: Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Mei-Han
authors.initials: MH
authors.lastname: Wu
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Hsu-Ching
authors.initials: HC
authors.lastname: Huang
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Tsai
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. Electronic address: jhchiou@vghtpe.gov.tw.
authors.forename: Chao-Hua
authors.initials: CH
authors.lastname: Chiu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000628:therapy*; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D017564:Radiation Pneumonitis / Q000139:chemically induced*; D012189:Retrospective Studies; D013909:Thorax / Q000528:radiation effects*; D013997:Time Factors
chemical_list: D047428:Protein Kinase Inhibitors; D066246:ErbB Receptors
keywords: epidermal growth factor receptor; nonsmall-cell lung cancer; radiation recall pneumonitis; radiotherapy; tyrosine kinase inhibitor