Steroid-withdrawal radiation pneumonitis in lung cancer patients with brain metastasis

Of 13 patients with lung cancer who received corticosteroid administration for brain metastasis after lung irradiation, 5 developed steroid-withdrawal severe acute radiation pneumonitis. All patients were male, their age distribution was 48 to 80 years old (mean 63 years old). In all patients, the symptom developed shortly after the rapid withdrawal or reduction of corticosteroid. Clinical signs were characterized by fever, dyspnea and cough. Chest radiograph showed pulmonary infiltrate promptly in the radiation field and extending beyond the geometric beam boundary. CT scan was sensitive for the detection of early change of radiation injury. Compared with the control group, the irradiated volume of lung was bigger and the interval of irradiation and corticosteroid administration was shorter in onset group. When steroid is employed after or during the lung irradiation, the dosage must be tapered for long period to avoid this complication. (author)