Radiation Pneumonitis

My Dad has has completed first round of chemo and radiation for his lung cancer. (ended in 9-10) In December he was diagnosed with Radiation Pneumonitis and spent 7 days in hospital on steroids. He is tapering off steriods now and is better from other side effects of treatment especially the nausea. He is so short of breath even with his oxygen since leaving hospital. Has anyone else had this happen to them and what are long term effects you have experienced?

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I have not dealt with this situation, all I can do is pass on what I have read. Hope this helps answer your questions.


http://lungcancer.about.com/od/treatmentoflungcancer/a/radpneumonitis.htm

"Radiation pneumonitis is an inflammation of the lungs due to radiation therapy. This side effect of radiation therapy occurs in 5 to 15% of people who go through radiation therapy for lung cancer, but can also result from radiation to the chest for breast cancer, lymphomas, or other cancers.

Radiation pneumonitis most commonly occurs between 1 and 6 months after completing radiation therapy. The risk of developing this complication depends on the dose of radiation used and the amount of tissue treated. It is more common if chemotherapy is given at the same time as radiation therapy, and is more likely to occur if you have other lung diseases, such as COPD. With treatment, most people recover from radiation pneumonitis without any lasting effects.

Treatment of Radiation Pneumonitis
Treatment of radiation pneumonitis is aimed at decreasing the inflammation. Steroids, such as prednisone, are given until the inflammation subsides and then slowly decreased over time.
Prognosis of Radiation Pneumonitis
Radiation pneumonitis usually resolves with treatment. If it goes untreated or persists, it can lead to pulmonary fibrosis (scarring of the lungs), which is often permanent."

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I could have sworn I posted on this but apparently I didn't "send" it.

I had radiation pneumonitis also . The steroids help but it does take time. Eventually your Dad will be fine.
I won't kid you and say his lungs will be completely normal because they won't.
As to SOB I strongly suggest you consult with a pulmonologist. Your Dad may have COPD. I wound up with COPD and am now on oxygen 24/7.

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I, too, had radiation pneumonitis. I was on Prednisone for about 9 months and then weaned off. It does take quite a while to recover. It can also lead to some permanent damage as well. My pulmonologist tells me I'm doing great 3 years later, with only 20% lung function lost and this includes an URL. I still have SOB but am not on oxygen.
Cheryll

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After I posted this yesterday, Daddy had to go to emergency room due to SOB. He has a mucus plug in bronchial tube. He is taking breathing treatment to try an loosen but may face bronchial scope to remove. I just hope this is not the tumor growing. Thanks for your replys.

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I zipped thru radiation peumonitis and landed on PULMONARY FIBROSIS which is fatal. Don't let it get to this point. Part of the lungs are permanently SHUT DOWN and the ramainder of the air sacs get thicker and thicker and thicker. Sound like a Stephen King novel. Oxygen forever and no treatment.

I don't even care about the cancer anymore because it does not make one iota of difference if I cannot breathe. I never should have been radiated with only 1 WBC (twice) I was suspiciously given 3 days off of radiation after having to promise to show up every day. I believe they realized what had happened.

Oops, it's too late now. Don't let this happen in your family.

Wishing you the best of luck.

carol

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Daddy has had bronchial scope and lungs were "washed". Dr. did not find mucus plug or cancer closing airway but feels constriction is due to radiation. Steriods elevated blood sugar level to 350 requiring insulin and cause heart rate to by tachacardia? and is also in heart medication. I hope none of these are permanent. Lung Dr. said he could improve with home breathing treatments. I am praying for complete healing.

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Dran

If your dad's therapy included Taxol, a commonly used anticancer drug, the radiation could be especially damaging to the lungs. In a study of more than 1300 cancer patients, those who took Taxol had a 14.6% chance of developing pneumonitis, an inflammation of the lungs, compared with 1.1% among those not using the drug (December 5, 2002 issue of the Journal of the National Cancer Institute).

Cancer patients need to add to their repertoire of specialists for their disease. A Physical Medicine and Rehabilitation Specialist for neuropathy, a Pulmonary Specialist for radiation pneumonitis, a Neurologist for leukoencephalopathy or worse, radiation-induced necrosis, an Infectious Disease Specialist for the infections that you will have to contend with for the rest of your life, and an Endocrinology & Metabolism Specialist, depending on what actually could be wrong with the patient.

Greg

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Thanks for all of the information. Daddy is still in the hospital hoping to go home today. He now has a cardiologist to add to the list of physicians. I appreciate the responses.

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Happy to hear your Dad is doing better and soon heading home. I was hoping you could share what his symptoms were before he started steroids. My Mom is feeling bad after having completed radiation (37 treatments) in August. She is on antibiotics bcs they think it is atypical pnemonia but is not feeling any better. The docs think she might also have radiation pnemonitis, but want to be sure it is not an infection before starting steroids. Since the antibiotics are not working, I am thinking it might be radiation pnemonits. Her symptoms are mainly that she feels weak - and at times gets feverish. Any insight would be appreciated.

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Daddy just kept getting weaker and felt so bad. His pain level also got worse. He thought he was dying to tell the truth. What sent us to the hospital was his oxygen level was down in the 70s at the doctors office just walking to the exam room. They made a chest x-ray and the doctor said he had infliltrates (sp) in the left lung with the cancer being in the right lung. The chest x-ray and shortness of breath him to the hospital. He was on I.V. antibiotics as a precaution but the steriods and breathing treatments were what helped. He did have a low grade fever but not bad. What I have read stated that white blood count could be up but not really infection present with this. I hope you find your answers but you may have to press the doctor. I think my dad had been sick for 2 weeks before he was hospitalized.

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Thank you for your reply. I spent the day with my mom today and she was feeling a little better. Hopefully things will continue to improve for both her and your dad. I'm on the lookout for signs of radiation pnemonitis.

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Daddy got results of PET scan today with new positive lymph nodes in abdomen. Original tumor is not active but shows something? around it. Dr. thinks it is still from radiation pneumonitis. He is too weak to have a biopsy or chemo therapy which would be the next step. He is going to stay on oral steriods and nebulizer treatments. Now I wonder what will get him first COPD or CA. You wait for that PET scan just to have to wait some more!!! I feel discouraged today. Any information would be greatly appreciated.

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I am so sorry to hear the PET scan results. I didn't know there were lymph nodes in the abdomen. Could the PET be registering something other than cancer there? Hope so. Also, hopefully a liitle more time on the steroids will help your dad regain his strength so they can do a biopsy and chemo if needed. He must be strong-willed to have made it through all the treatments he has already been through. I'll be thinking of you both and hoping for the best.

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Thank you for your words of encouragement. I need them right now.

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My dad is not getting better from the radiation pneumonitis. It has been a month since his dx and he just gets weaker and weaker. How is radiation fibrosis diagnosed? At this point I don't think we should be worried about the new lymph nodes in the abdomen. I would like to know what is going to happen next? Please advise.

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I PM'd Dran with some information, but I want to present this to others who may be in the same situation. There may be a different approach to attack this situation.

Researchers have found that using a special type of drug called a pharmaceutical monoclonal antibody to block the integrin beta6-TGF-beta pathway prevents a serious side effect of radiation therapy for lung cancer patients with pulmonary fibrosis (scarring of the lungs), thereby extending patients lives and improving their quality of life, according to a study presented at the Plenary I session on October 29, 2007, at the American Society for Therapeutic Radiology and Oncology's 49th Annual Meeting in Los Angeles.

The toxicity of pulmonary fibrosis limits the amount of the radiation dose that can be safely given to patients, said Simon Cheng, M.D., Ph.D., an author of the study and a radiation oncologist at New York University Medical Center in New York. The study results may lead to more effective radiation therapies for advanced lung cancer, which is the leading cause of cancer deaths in the U.S.

More than 50 percent of patients receiving radiation therapy for advanced lung cancer develop radiation-induced lung fibrosis, a painful side effect that can affect patient's quality of life and, in some cases, can be fatal. Pulmonary (lung) fibrosis involves inflammation and scarring of the lungs causing patients to feel short of breath, have a chronic dry cough, feel fatigue and pain in the chest, and suffer loss of appetite and weight loss. Over time, fibrosis causes the air sacs of the lungs to be replaced by scar tissue, causing difficulty breathing and an irreversible loss of the tissue's ability to transfer oxygen into the bloodstream.

This study involved mice treated with a 14 Gy single dose of radiation to the lungs. Researchers wanted to determine if using an antibody to block integrin beta6 (a specific activator of the transforming growth factor (TGF-beta) signaling pathway), could prevent the onset of radiation-induced pulmonary fibrosis. The study shows that mice that were given integrin beta6 monoclonal antibodies did not develop radiation-induced lung fibrosis, while the control group of mice developed the lung condition.

Fibrosis is a very serious side effect that often keeps doctors from giving patients a full dose of radiation for fear that the serious problems caused by fibrosis will outweigh the good done by the radiation. If further studies conclude that this drug can indeed prevent fibrosis in lung cancer patients, I believe researchers are a huge step closer to curing this disease, said Dr. Cheng.

Now, Avastin has a role in both VEGF and TGF-beta signaling pathways (it is a monoclonal antibody). Here is some very new and interesting information about fighting radiation-induced necrosis (which is something my wife had in her brain from over-aggressive whole brain radiation) with Avastin.

When brain tumors are treated with radiation therapy, there is always a risk of radiation-induced necrosis of healthy brain tissue. Insidious and potentially fatal, radiation necrosis of the brain may develop months or even years after irradiation.

This poorly understood side effect can occur even when the most stringent measures are taken to avoid exposing healthy tissue to harmful levels of radiation. In most cases, radiation necrosis of the brain occurs at random, without known genetic or other predisposing risk factors. The only treatment options typically available for radiation necrosis of the brain are surgery to remove dead tissue and use of the steroid dexamethasone to provide limited symptom control. But clinicians have not found a way to stop the progression of necrosis, despite having tested a range of therapies including anticoagulants, hyperbaric oxygen, and high-dose anti-inflammatory regimens.

However, recent studies at M. D. Anderson have shown that the monoclonal antibody bevacizumab (Avastin) may be able to stop radiation necrosis of the brain and allow some of the damage to be reversed. Victor A. Levin, M.D., a professor in the Department of Neuro-Oncology and the senior researcher on the studies, said the findings suggest that radiation necrosis of the brain can be successfully managed—and perhaps even prevented—with bevacizumab or similar drugs.

You can read that here: http://www2.mdanderson.org/depts/oncolog/articles/09/5-may/5-09-2.html

While the above study involved mice, the Anderson study involves Avastin treatment for radiation-induced necrosis on human beings. Perhaps Avastin could be a treatment for radiation fibrosis? This may be something for someone's physician (hopefully their pulmonary specialist) to contact MD Anderson to find out if this would work with radiation fibrosis. Since Dr. Victor A. Levin retired, I'm sure his associates are further investigating this new finding.

Thanks Dran for being inquisitive and asking questions. That's part of being Inspired with Hope. Until tonight, I never thought about this possible association. Of course, until recently, no one thought about the association of Avastin and radiation-induced necrosis either.

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Hi Dran4,

My mother was recently diagnosed with Radiation Pneumonitis but was not prescribed breathing treatments. Do you know what your father is taking? My mom has a horrible cough and a lot of mucous that is not very productive. Also when she can get some up it is a very gold color. They have her on 40mg AM / 20 mg PM of steroids...however she doesn't seem to be improving. She is also on oxygen 24/7...that was after being hospitalized with regular pneumonia about a month ago. (which also makes me wonder if the original pneumonia was misdiagnosed ani it was the radiation pneumonitis the whole time)

Any help or advice you could provide would be greatly appreciated!

Thank you!

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Hey Dran,
Your discussion has been bumped up to active with a new reply today. I was wondering how your dad is now. I was going to reply, then realised it was back in January when you first posted. My observation was to be that I thought with radiation pneumonitis long term course treatment with steroids was necessary, and it seemed that your dad only had them for a couple of weeks.
I hope your dad is recovering well,
with love and best wishes, Carolyn

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Thank you so much for your inquiry about my Daddy. He passed away 3 weeks ago. I am so thankful to God that he had a peaceful death with my Mother and all four of his children with him. It has been so hard especially for my Mother. We know his is in Heaven and not suffering any longer but our grief is strong right now. I appreciate everyone in the Inspire group that held my "hand" through his illness.

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I would ask for the breathing treatments! He was also on Mucinex to thin the secretions. When patients are weak it is hard for them to cough up much. I think it must be difficult to diagnosis the radiation pneumonitis. She may need to continue on with an antibiotic even though Daddy's pneumonia resolved with one round of antibiotics. I hope she recovers soon.

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