Pozzessere Chiara, Bouchaab Hasna, Jumeau Raphael, Letovanec Igor, Daccord Cécile, Bourhis Jean, Prior John O, Peters Solange, Lazor Romain, Beigelman-Aubry Catherine
Dept of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Joint first authors.
ERJ Open Res. 2020 Mar 16;6(1). doi: 10.1183/23120541.00165-2019. eCollection 2020 Jan.
In patients with primary or secondary lung tumour treated with immune checkpoint inhibitors, immune-related pneumonitis is a rare adverse event but may evolve to respiratory failure. Prompt management is required and usually consists of treatment interruption and immunosuppressive drug administration. The aim of this study was to evaluate relationships between immune-related pneumonitis and pre-existing parenchymal status, especially tumour location and history of chest radiotherapy. Computed tomography (CT) scans of patients with immune-related pneumonitis were retrospectively reviewed. Pattern, distribution and extent of pneumonitis were assessed in six lung regions. In patients who received radiotherapy, the extent of pneumonitis was evaluated according to the radiation field. Among 253 patients treated with immunotherapy, 15 cases of immune-related pneumonitis were identified. 10 had previous or concomitant chest radiotherapy in addition to immunotherapy. At CT scan, 29 (33%) out of 88 regions encompassed the primary tumour (n=4), a lung metastasis (n=4) and/or radiation fields (n=21). A significantly higher prevalence of parenchymal involvement by immune-related pneumonitis occurred within areas of primary or metastatic malignancy and/or radiation field (97%) as compared to other areas (3%, p=0.009). Lung regions affected by the primary tumour, metastasis or radiotherapy had a higher probability of immune-related pneumonitis than others (OR 10.8, p=0.024). An organising pneumonia (OP) pattern was more frequent after radiotherapy (70% 0%, p=0.024), whereas nonspecific interstitial pneumonia features were more commonly seen in radiotherapy-naive patients (100% 10%, p=0.002). In patients with primary or secondary lung tumour treated with immune checkpoint inhibitors, immune-related pneumonitis is preferentially located within lung areas involved by tumour and/or radiation fields.
在接受免疫检查点抑制剂治疗的原发性或继发性肺肿瘤患者中，免疫相关性肺炎是一种罕见的不良事件，但可能进展为呼吸衰竭。需要及时处理，通常包括中断治疗和给予免疫抑制药物。本研究的目的是评估免疫相关性肺炎与既往实质状态之间的关系，尤其是肿瘤位置和胸部放疗史。对免疫相关性肺炎患者的计算机断层扫描（CT）图像进行回顾性分析。在六个肺区域评估肺炎的类型、分布和范围。对于接受过放疗的患者，根据放射野评估肺炎的范围。在253例接受免疫治疗的患者中，确诊15例免疫相关性肺炎。其中10例在接受免疫治疗的同时还接受过胸部放疗或有胸部放疗史。在CT扫描中，88个区域中有29个（33%）包含原发性肿瘤（n = 4）、肺转移瘤（n = 4）和/或放射野（n = 21）。与其他区域相比，免疫相关性肺炎在原发性或转移性恶性肿瘤区域和/或放射野内的实质受累患病率显著更高（97%对3%，p = 0.009）。受原发性肿瘤、转移瘤或放疗影响的肺区域发生免疫相关性肺炎的概率高于其他区域（比值比10.8，p = 0.024）。放疗后机化性肺炎（OP）模式更常见（70%对0%，p = 0.024），而在未接受放疗的患者中更常见非特异性间质性肺炎特征（100%对10%，p = 0.002）。在接受免疫检查点抑制剂治疗的原发性或继发性肺肿瘤患者中，免疫相关性肺炎优先发生在受肿瘤和/或放射野累及的肺区域。
