Steroid-refractory radiation pneumonitis treated with cyclosporin A

A 79-year-old man was referred to our hospital with a squamous cell carcinoma of the lung. Concurrent chemoradiation (carboplatin (CBDCA)+paclitaxel (PTX)) was performed. One month after completion of chest irradiation (total 60 Gy), radiation pneumonitis (RP) occurred in the right lung field. Symptoms initially improved after administration of prednisolone, but worsened after tapering to a dose of 20 mg per day. Respiratory failure progressed and 67Ga scan findings showed diffuse increased uptake in both lung fields, indicating the exacerbation of RP even in the contra-lateral lung where no irradiation was given. Methylprednisolone administration was commenced, but it was difficult to reduce prednisolone to less than 40 mg per day. Thus, this patient was considered to be a steroid-refractory case. Cyclosporin A administration promptly relieved his symptoms and reduced serum KL-6 and SP-D levels to a normal range and oxygen amount. Cyclosporin A can be useful in the treatment of corticosteroid-refractory radiation pneumonitis. (author)