irradiating the lung , how much inflammation is ecceptable ?

Portal Forums Radiation Oncology Chest Radiation irradiating the lung , how much inflammation is ecceptable ?

This topic contains 6 replies, has 2 voices, and was last updated by  kempten 11 months ago.

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December 22, 2016 at 8:48 pm  #1289605    

kempten

Hello

I am receiving 15 radiation treatments to my 3.5 cm lung lesion and a 1.5 cm lymph node.
My doctors where first reluctant but now actually recommended irradiating the lung lesion because it is the only progression amongst otherwise stable disease during Tagrisso therapy.
The first 3 treatments where a piece of cake , but today after the 4th I started to feel the fatigue coming on
and also had some very slight nausea and some slight chills. Enough that I wanted to go right to bed after I came home. My cough that has been present for several months also seems to be a bit worse.

My question to you is :

How can one distinguish between normal lung irradiation symptoms and the beginnings of pneumonitis.
Are there any lab tests or breathing tests that can tell oncologists if symptoms might be associated with pneumonitis.

I do not have a fever.
I was allowed to continue my Tagrisso therapy throughout radiation treatment . We discussed the tradeoff
between stopping systemic therapy and risking worsening disease in the CNS and the risk of pneumonitis.

I would guess that some lung inflammation is bound to happen and that this is the cause of my symptoms.
Can I assume that lung inflammation exists on a continuum from normal to deadly ? How do the professionals know when to treat ?

Thanks
Kempten

December 22, 2016 at 10:50 pm  #1289607    
catdander forum moderator
catdander forum moderator

In the following quotes notice that the time frame for pneumonitis is usually in the range of weeks after treatment is completed, they aren’t taking into consideration the higher than usual propensity of tagrisso induced pneumonitis. This is a dangerous path so if pneumonitis does occur fast treatment will be key in stopping it. So please keep your healthcare team well informed of new or worsening symptoms.

“Pneumonitis is one of the risk factors associated with radiation treatment to the lung. Radiation pneumonitis is an inflammatory reaction that resembles a pneumonia that typically occurs in patients 6-24 weeks after they have completed radiation treatment. The symptoms of radiation pneumonitis are often similar to the symptoms one experiences when one has a pneumonia or the bad flu. Patients can complain of a cough, shortness of breath, or even chest fullness. Most patients who develop these symptoms after radiation report that the symptoms resolve by themselves in 7-10 days. A few of the patients have really severe symptoms and come in to be evaluated by a physician. If the diagnosis of radiation pneumonitis is made, then patients can be treated quite effectively with a short course of steroids.” http://cancergrace.org/radiation/2008/08/11/pneumonitis/

“Radiation pneumonitis is symptomatically similar to the condition that we all know as pneumonia, but the cause is not infectious – hence the more general term “pneumonitis” referring to an inflammatory process (“-itis”) of the lung (“pneumo-“). Patients with radiation pneumonitis experience cough, fever, chills, and shortness of breath. Chest x-ray or cat scan of the chest demonstrates infiltration of the lung with fluid (similar to imaging findings in cases of infectious pneumonia), which tends to be in the area of prior radiation therapy field coverage. ” http://cancergrace.org/radiation/2012/02/18/v20/

Hoping to hear of good outcomes. Many wishes and hopes sent your way.
Janine

December 22, 2016 at 10:59 pm  #1289608    
catdander forum moderator
catdander forum moderator

Since there is a known relationship between tagrisso and pneumonitis/ild there aren’t data or much clinical experience to say what the spectrum looks like in your situation. Don’t hesitate to go to ER if you’re worried. I know you and your oncologists are working with impractical odds but I’m glad you’re involved in your own care and decision making. I know it makes a difference having that power.

Keeping you in my thoughts and highest hopes.
Janine

December 23, 2016 at 5:58 am  #1289614    

kempten

Thank you Janine for your answer.
I will call my oncologist and let them know I would like to be evaluated frequently throughout and after my treatment so that we can catch any dangerous developments in time.
Do you know if checking your blood for inflammation markers or elevated leucocytes would help detect trouble early?

December 23, 2016 at 10:15 am  #1289616    
catdander forum moderator
catdander forum moderator

From the link below scanning appears to be the least invasive way to diagnose ild and blood tests aren’t used.

http://www.mayoclinic.org/diseases-conditions/interstitial-lung-disease/basics/tests-diagnosis/con-20024481

December 23, 2016 at 10:23 am  #1289617    
catdander forum moderator
catdander forum moderator

Measuring the oxygen in the blood with oximetry that clips on the finger would be used as well. But sob would probably be detected by you. Ask your doc if that’s something you can use as a way to keep tabs from home. But that’s an idea coming from me as a the lay person , I’ve not seen or heard of doing that.

December 23, 2016 at 12:29 pm  #1289623    

kempten

Thanks again Janine

Today I talked to my radiation oncologist and we think that my immune system which seems to be chronically upregulated ( Interstitial cystitis, chronic fatigue immune dysfunction syndrome ) is reacting to the radiation and dying tumor cells which caused the slight flue like symptoms..
Today after the 5th treatment I don’t have the same flue like symptoms interestingly.
I have 3 days to relax over the holidays before the next treatments . We will monitor the situation closely.

Happy Holidays

Kempten

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