Garrido Marcelo, O'Brien Andrés, González Sergio, Clavero José Miguel, Orellana Eric
Departamentos de Hematología-Oncología, Centro de Cáncer, Pontificia Universidad Católica de Chile, Santiago, Chile.
Chest. 2007 Dec;132(6):1997-9. doi: 10.1378/chest.07-0536.
The patient presented here is a 30-year-old woman who underwent anterior resection for the initial treatment of rectal cancer. A postoperative study showed a single liver metastasis. The patient received adjuvant pelvic radiotherapy with concomitant 5-fluorouracil (5-FU) treatment followed by liver metastasectomy 6 weeks after the completion of radiation therapy and chemotherapy. Adjuvant therapy with 5-FU, leucovorin, and oxaliplatin (FOLFOX 4 regimen) was continued. The initial five cycles were well tolerated with the occurrence of only paresthesia that did not interfere with function. After the sixth cycle of the treatment, progressive dyspnea and persistent cough developed in the patient, although her clinical history was negative for lung disease. A chest radiograph revealed diffuse bilateral interstitial infiltrates, and a chest CT scan showed bilateral alveolar infiltrates predominant in the right lung. Lung biopsy by video-assisted thoracoscopy was performed, and the histologic report showed cryptogenic organizing pneumonitis (COP). Prednisone therapy (1 mg/kg/d) resulted in a very good clinical response. In fact, the patient had complete remission of respiratory symptoms including cough and dyspnea after 4 days of treatment, and the chest CT scan showed complete resolution of lung infiltrates after 4 weeks. One month later, the patient continued adjuvant treatment with six cycles of 5-FU, leucovorin, and irinotecan (ie, the FOLFIRI regimen) without complications. Thus, oxiplatin was implicated as the likely cause of this drug-induced lung toxicity, which is a very rare complication associated with platins. Diffuse interstitial lung disease, particularly COP, has been described following the administration of the cytotoxic agents bleomycin and busulfan, but a connection to oxaliplatin has not been reported before this case.
本文介绍的患者是一名30岁女性,因直肠癌接受了初次手术,行前切除术。术后检查发现单发肝转移。患者接受了盆腔辅助放疗,并同时使用5-氟尿嘧啶(5-FU)治疗,放疗和化疗结束6周后进行了肝转移灶切除术。继续使用5-FU、亚叶酸钙和奥沙利铂进行辅助治疗(FOLFOX 4方案)。最初的五个周期耐受性良好,仅出现未影响功能的感觉异常。在第六个周期治疗后,患者出现进行性呼吸困难和持续性咳嗽,尽管其肺部疾病临床病史为阴性。胸部X线片显示双侧弥漫性间质浸润,胸部CT扫描显示双侧肺泡浸润,以右肺为主。通过电视辅助胸腔镜进行了肺活检,组织学报告显示为隐源性机化性肺炎(COP)。泼尼松治疗(1mg/kg/d)产生了非常好的临床反应。事实上,患者在治疗4天后咳嗽和呼吸困难等呼吸道症状完全缓解,胸部CT扫描显示4周后肺部浸润完全消退。1个月后,患者继续接受六个周期的5-FU、亚叶酸钙和伊立替康辅助治疗(即FOLFIRI方案),未出现并发症。因此,奥沙利铂被认为是这种药物性肺毒性的可能原因,这是一种与铂类药物相关的非常罕见的并发症。在使用细胞毒性药物博来霉素和白消安后曾有弥漫性间质性肺病,特别是COP的报道,但在此病例之前尚未有与奥沙利铂相关的报道。