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Japanese Journal of Clinical Oncology Advance Access published online on May 15, 2006
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyl021
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© 2006 Foundation for Promotion of Cancer Research
Received October 10, 2005
Accepted February 8, 2006

Original Article

Interstitial Shadow on Chest CT is Associated with the Onset of Interstitial Lung Disease Caused by Chemotherapeutic Drugs

Seiji Niho 1 *, Koichi Goto 1, Kiyotaka Yoh 1, Young Hak Kim 1, Hironobu Ohmatsu 1, Kaoru Kubota 1, Nagahiro Saijo 1, and Yutaka Nishiwaki 1

1 Division of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan

* To whom correspondence should be addressed.
Seiji Niho, E-mail: siniho{at}east.ncc.go.jp


  Abstract

Objective: Pretreatment computerized tomography (CT) films of the chest was studied to clarify the influence of interstitial shadow on developing interstitial lung disease (ILD).

Methods: Eligible patients were those lung cancer patients who started to receive first-line chemotherapy between October 2001 and March 2004. Patients who received thoracic radiotherapy to the primary lesion, mediastinum, spinal or rib metastases were excluded. We reviewed pretreatment conventional CT and plain X-ray films of the chest. Ground-glass opacity, consolidation or reticular shadow without segmental distribution was defined as interstitial shadow, with this event being graded as mild, moderate or severe. If interstitial shadow was detected on CT films of the chest, but not via plain chest X-ray, it was graded as mild. Patients developing ILD were identified from medial records.

Results: A total of 502 patients were eligible. Mild, moderate and severe interstitial shadow was identified in 7, 8 and 5% of patients, respectively. A total of 188 patients (37%) received tyrosine kinase inhibitor (TKI) treatment, namely gefitinib or erlotinib. Twenty-six patients (5.2%) developed ILD either during or after chemotherapy. Multivariate analyses revealed that interstitial shadow on CT films of the chest and treatment history with TKI were associated with the onset of ILD.

Conclusions: It is recommended that patients with interstitial shadow on chest CT are excluded from future clinical trials until this issue is further clarified, as it is anticipated that use of chemotherapeutic agents frequently mediate onset of ILD in this context.

Keywords: interstitial lung disease; interstitial shadow; chemotherapy; lung cancer; CT.
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